title: Prospective multicenter study of combined treatment with chemotherapy and radiotherapy in breast cancer women with the rare clinical scenario of ipsilateral supraclavicular node recurrence without distant metastases.
abstract: OBJECTIVE
  To evaluate the role of chemotherapy combined with curative radiotherapy in breast cancer patients who presented with recurrent ipsilateral supraclavicular lymph node metastases (ISLM) without "nonregional disease," we designed an observational study performed prospectively.
  
  
  METHODS
  Forty-four consecutive patients with ISLM from breast cancer as part of recurrent regional disease without distant metastases were included in this study. All patients received chemotherapy with doxorubicin-based schema or paclitaxel for six courses and curative radiotherapy (60 Gy/30 fractions of 2 Gy/5 days a week). An "involved field" radiation was delivered during the interval between the third and fourth chemotherapy course; hormonal therapy was given based on receptor status.
  
  
  RESULTS
  The rate of overall clinical response after chemotherapy and radiotherapy was 94.9%. Median time to progression and overall survival were 28 and 40 months, respectively; the 5-year actuarial overall survival and disease-free survival rates were 35% (95% confidence interval, 19-51) and 20% (95% confidence interval, 6-34), respectively.
  
  
  CONCLUSIONS
  A curative course of intravenous chemotherapy and radical irradiation is feasible in patients with ISLM. All patients presenting recurrence in supraclavicular nodes should be treated with definitive locoregional treatments and systemic therapy because the outcomes are better than might be historically assumed.
authors.affiliation: Department of Radiological Science, University of Messina, Messina, Italy. Stefano.Pergolizzi@unime.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Pergolizzi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Adamo
authors.forename: Elvio
authors.initials: E
authors.lastname: Russi
authors.forename: Anna
authors.initials: A
authors.lastname: Santacaterina
authors.forename: Roberto
authors.initials: R
authors.lastname: Maisano
authors.forename: Gianmauro
authors.initials: G
authors.lastname: Numico
authors.forename: Carmela
authors.initials: C
authors.lastname: Palazzolo
authors.forename: Francesco
authors.initials: F
authors.lastname: Ferraù
authors.forename: Nicola
authors.initials: N
authors.lastname: Settineri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Altavilla
authors.forename: Andrea
authors.initials: A
authors.lastname: Girlando
authors.forename: Pietro
authors.initials: P
authors.lastname: Spadaro
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D002968:Clavicle; D003131:Combined Modality Therapy / Q000379:methods; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008198:Lymph Nodes; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000532:radiotherapy*; D009367:Neoplasm Staging / Q000379:methods; D017239:Paclitaxel / Q000008:administration & dosage; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D016019:Survival Analysis
chemical_list: D004317:Doxorubicin; D003520:Cyclophosphamide; D017239:Paclitaxel; D005472:Fluorouracil