Prognostic fa
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
