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Outcome of radiotherapy for clinically overt metastasis to the internal mammary lymph node in patients receiving neoadjuvant chemotherapy and breast cancer surgery

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Abstract
Purpose: This study was aimed to assess the outcome of radiotherapy and determine prognostic factors for survival in breast cancer patients with clinically overt metastasis to the internal mammary lymph node (IMN+).

Methods: We retrospectively reviewed the medical records of 193 patients with IMN + breast cancer who received neoadjuvant chemotherapy (NAC), breast surgery without internal mammary lymph node (IMN) dissection, and postoperative radiotherapy at 9 hospitals between 2009 and 2013. Breast conserving surgery or mastectomy was performed after taxane-based NAC. Radiotherapy was administered to the whole breast/chest wall and regional nodes. IMN-covering radiotherapy was performed in 92.2% of patients with median dose of 58.4 Gy (range, 44.9-69.1 Gy). The overall survival (OS), disease free survival (DFS), and IMN failure-free survival (IMNFFS) were analyzed.

Results: After median follow-up of 71 months, 9 patients (4.7%) developed IMN failure and simultaneous distant metastasis. The 5-year DFS, OS, and IMNFFS was 68.6%, 81.8%, and 95.3%, respectively. Non-triple negative breast cancer, Ki-67 < 10%, pathological complete response (CR) in tumor and axillary node, and radiologic CR of IMN after NAC were significant factors for predicting higher DFS; however, IMN radiation dose was not significant determinants for DFS. The 5-year DFS of patients with IMN-dose 50.0 Gy and those with 50.0 Gy was 86.7% and 76.7%, respectively (p = 0.41).

Conclusions: A multimodality strategy including NAC, breast surgery, and IMN-covering radiotherapy was effective for patients with overt IMN + breast cancer. Even without an IMN dissection, most patients were IMN failure-free with an IMN-focusing radiotherapy. (C) 2020 The Author(s). Published by Elsevier Ltd.
Author(s)
김규보김수산김용배김진희김해영박원신경환양경미이동수이익재장지석장지현정진홍차지혜최두호
Issued Date
2021
Type
Article
Keyword
Breast cancerInternal mammalian lymph nodeNeoadjuvant therapyRadiotherapy(2020A02567)
DOI
10.1016/j.breast.2020.12.011
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7347
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_doaj_primary_oai_doaj_org_article_ea81163dc7bb4d35a6908e4b6c96e06d&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Outcome%20of%20radiotherapy%20for%20clinically%20overt%20metastasis%20to%20the%20internal%20mammary%20lymph%20node%20in%20patients%20receiving%20neoadjuvant%20chemotherapy%20and%20breast%20cancer%20surgery&amp;offset=0&amp;pcAvailability=true
Publisher
BREAST
Location
네덜란드
Language
영어
ISSN
0960-9776
Citation Volume
55
Citation Number
0
Citation Start Page
112
Citation End Page
118
Appears in Collections:
Medicine > Medicine
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