Prognostic Impact of Elective Supraclavicular Nodal Irradiation for Patients with N1 Breast Cancer after Lumpectomy and Anthracycline Plus Taxane-Based Chemotherapy (KROG 1418): A Multicenter Case-Controlled Study

Haeyoung Kim; Won Park; Jeong Il Yu; Doo Ho Choi; Seung Jae Huh; Yeon-Joo Kim; Eun Sook Lee; Keun Seok Lee; Han-Sung Kang; In Hae Park; Kyung Hwan Shin; Chan Woo Wee; Kyubo Kim; Kyung Ran Park; Yong Bae Kim; Sung Ja Ahn; Jong Hoon Lee; Jin Hee Kim; Mison Chun; Hyung-Sik Lee; Jung Soo Kim; Jihye Cha

doi:10.4143/crt.2016.382

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Prognostic Impact of Elective Supraclavicular Nodal Irradiation for Patients with N1 Breast Cancer after Lumpectomy and Anthracycline Plus Taxane-Based Chemotherapy (KROG 1418): A Multicenter Case-Controlled Study

Authors: Haeyoung Kim ; Won Park ; Jeong Il Yu ; Doo Ho Choi ; Seung Jae Huh ; Yeon-Joo Kim ; Eun Sook Lee ; Keun Seok Lee ; Han-Sung Kang ; In Hae Park ; Kyung Hwan Shin ; Chan Woo Wee ; Kyubo Kim ; Kyung Ran Park ; Yong Bae Kim ; Sung Ja Ahn ; Jong Hoon Lee ; Jin Hee Kim ; Mison Chun ; Hyung-Sik Lee ; Jung Soo Kim ; Jihye Cha

Citation: CANCER RESEARCH AND TREATMENT, Vol.49(4) : 970-980, 2017-10

Journal Title: CANCER RESEARCH AND TREATMENT

ISSN: 1598-2998

Issue Date: 2017-10

MeSH: Adult ; Aged ; Anthracyclines / administration & dosage ; Antineoplastic Combined Chemotherapy Protocols / adverse effects ; Antineoplastic Combined Chemotherapy Protocols / therapeutic use ; Breast Neoplasms / mortality* ; Breast Neoplasms / pathology ; Breast Neoplasms / radiotherapy* ; Bridged-Ring Compounds / administration & dosage ; Case-Control Studies ; Combined Modality Therapy ; Female ; Humans ; Lymphatic Metastasis ; Mastectomy, Segmental ; Middle Aged ; Neoplasm Staging ; Postoperative Care* ; Prognosis ; Radiotherapy Dosage ; Radiotherapy, Adjuvant ; Survival Analysis ; Taxoids / administration & dosage ; Treatment Outcome

Keywords: Adjuvant radiotherapy ; Breast neoplasms ; Case-control studies ; Lymphatic irradiation ; Taxane

Abstract: Purpose: This study was conducted to evaluate the impact of supraclavicular lymph node radiotherapy (SCNRT) on N1 breast cancer patients receiving post-lumpectomy whole-breast irradiation (WBI) and anthracycline plus taxane-based (AT) chemotherapy.

Materials and methods: We performed a case-control analysis to compare the outcomes of WBI and WBI plus SCNRT (WBI+SCNRT). Among 1,147 patients with N1 breast cancer who received post-lumpectomy radiotherapy and AT-based chemotherapy in 12 hospitals, 542 were selected after propensity score matching. Patterns of failure, disease-free survival (DFS), distant metastasis-free survival (DMFS), and treatment-related toxicity were compared between groups.

Results: A total of 41 patients (7.6%) were found to have recurrence. Supraclavicular lymph node (SCN) failure was detected in three patients, two in WBI and one in WBI+SCNRT. All SCN failures were found simultaneously with distant metastasis. There was no significant difference in patterns of failure or survival between groups. The 5-year DFS and DMFS for patients with WBI and WBI+SCNRT were 94.4% versus 92.6% (p=0.50) and 95.1% versus 94.5% (p=0.99), respectively. The rates of lymphedema and radiation pneumonitis were significantly higher in the WBI+SCNRT than in the WBI.

Conclusion: We did not find a benefit of SCNRT for N1 breast cancer patients receiving AT-based chemotherapy.