Prognostic factors for supraclavicular relapse in N1 breast cancer patients. May that judge the need for supraclavicular irradiation?
Emad Sadaka, Alaa Maria and Mohamed El-Shebiney
Clinical Oncology Department, Faculty of Medicine, Tanta University, Gharbia, Egypt.
Abstract: Background: Post-mastectomy radiation therapy (PMRT) for patients with Stages II and III breast cancer has shown a significant benefit in locoregional control, disease free survival, and overall survival. However, the issue of those patients with 1-3 positive lymph nodes (LNs) should receive PMRT and, if so, to what volumes, remains a controversy among radiation oncologists. In the current study, we evaluated the prognostic factors for supraclavicular relapse in N1 breast cancer patients that may judge the need for supraclavicular radiation therapy (SCRT) Material and Methods: This is a retrospective study conducted at Clinical Oncology department, Tanta University Hospital, between Jan. 2001 and December 2007. The study included 113 female breast cancer patients treated with breast conserving surgery (BCS) or modified radical mastectomy (MRM) and axillary evacuation. All patients had pathologically proved breast cancer with T1-T3 N1 M0 tumors. MRM was performed in 66.4% of patients and axillary LN dissection was performed in all patients. Chest wall irradiation after chemotherapy is given for patients who underwent BCS, patients with high risk T2 and T3 tumor size. Eighty-seven patients received adjuvant chemotherapy and patients with positive hormonal receptors received hormonal therapy for 5 years. Results: Overall locoregional relapse rate (LRR) was 16.8% and supraclavicular relapse (SCR) was 9.7%. The overall 5-year supraclavicular recurrence free survival(SCRFS) was 90.15%. In univariate analysis, SCRFS was significantly correlated to tumor size (p<0.0001), number of positive axillary LNs (p=0.0006), percentage of +ve axillary LN (p=0.002), extracapsular extension (ECE) (p=0.0001) and lymphovascular invasion (LVI) (p=0.003). Tumor size, percentage of +ve axillary LN and ECE were independent prognostic factors in multivariate analysis for SCRFS (p=0.011, 0.004 and 0.036 respectively). Accordingly, patients were classified into 2 groups; the low risk group (0-1 prognostic factor) and the high risk group (2-3 prognostic factors). Low risk group had a 5-yearstatistically significant benefit in SCRFS rate (97.6% and 68.97% respectively, p<0.0001). Conclusion:SCRT is recommended for patients with N1 who had ≥2 independent prognostic risk factors.
[Emad Sadaka, Alaa Maria and Mohamed El-Shebiney. Prognostic factors for supraclavicular relapse in N1 breast cancer patients. May that judge the need for supraclavicular irradiation? J Am Sci2012;8(10):808-813]. (ISSN: 1545-1003). http://www.jofamericanscience.org. 109
Key words: Breast cancer, Supraclavicular recurrence, Prognostic factors, Supraclavicular radiation therapy Full Text 109