title: Ipsilateral supraclavicular lymph nodes metastases from breast cancer as only site of disseminated disease. Chemotherapy alone vs. induction chemotherapy to radical radiation therapy.
abstract: BACKGROUND
  To define the role of radiotherapy (RT) in the treatment of ipsilateral supraclavicular lymph-nodes metastases (ISLM) from breast cancer as only site of disseminated disease, we started a prospective non-randomized clinical trial in 1989. Here we report the final results with a median follow-up of 8.75 years.
  
  
  METHODS
  Thirty-seven patients (pts), with ISLM from breast cancer, were consecutively enrolled into two arms. Arm A (18 pts): chemotherapy (CT) for six courses. Arm B (19 pts): CT for three courses followed by RT to the site of ISLM at 'radical' dose of 50-60 Gy.
  
  
  RESULTS
  In arm A, a median Time to Progression (TtP) of 7 months with a median Overall Survival (OS) of 28 months was recorded. In comparison, patients in arm B had a longer median TtP with 20 months as well as a better median OS with 41 months, respectively. An actuarial five-year disease-free survival of 5.5% was obtained in arm A vs. 21% in arm B. A statistically significant difference in TtP was demonstrated between the two groups (P = 0.01).
  
  
  CONCLUSIONS
  These data demonstrate that a better event-free survival could be achieved in patients with ISLM submitted to induction CT and radical irradiation. This also translated into a longer survival although this did not achieve statistical significance. We want to stress the importance of local control by RT since it does imply that not all of these patients have micrometastases at the time of relapse in the supraclavicular fossa.
authors.affiliation: Institute of Radiological Science, Department of Radiation Oncology University of Messina, Italy. pergoste@solnet.it
authors.forename: S
authors.initials: S
authors.lastname: Pergolizzi
authors.forename: N
authors.initials: N
authors.lastname: Settineri
authors.forename: A
authors.initials: A
authors.lastname: Santacaterina
authors.forename: P
authors.initials: P
authors.lastname: Spadaro
authors.forename: R
authors.initials: R
authors.lastname: Maisano
authors.forename: N
authors.initials: N
authors.lastname: Caristi
authors.forename: V
authors.initials: V
authors.lastname: Adamo
authors.forename: C
authors.initials: C
authors.lastname: De Renzis
authors.forename: M
authors.initials: M
authors.lastname: Mesiti
authors.forename: S
authors.initials: S
authors.lastname: Cascinu
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis