title: Locoregional treatment outcomes for breast cancer patients with ipsilateral supraclavicular metastases at diagnosis.
abstract: OBJECTIVE
  To evaluate the locoregional efficacy of multimodality treatment for breast cancer patients who present with ipsilateral supraclavicular (SCV) disease without systemic metastases.
  
  
  METHODS
  We retrospectively reviewed the data from 71 patients with ipsilateral SCV involvement at presentation. SCV involvement in 16 patients (23%) was diagnosed by ultrasound examination only, without palpable disease. All patients were treated with curative intent using neoadjuvant chemotherapy, mastectomy or breast-conserving surgery (BCT), and radiotherapy.
  
  
  RESULTS
  The 5-year SCV control, locoregional control (LRC), disease-free survival, and overall survival rate was 90%, 77%, 30%, and 47%, respectively. Patients with persistent SCV disease after neoadjuvant chemotherapy by physical examination had a lower rate of LRC (64% vs. 86%, p = 0.026), as did those with persistent SCV disease by ultrasound examination (66% vs. 96%, p = 0.007). Of those with a complete response of SCV disease by physical examination after neoadjuvant chemotherapy, those with persistently abnormal ultrasound findings had significantly worse disease-free survival (0% vs. 55%, p = 0.03). BCT was not associated with lower rates of LRC (82% for BCT vs. 76% for mastectomy, p = 0.80).
  
  
  CONCLUSIONS
  Radiotherapy achieved excellent LRC after surgery for patients with ipsilateral SCV metastases who achieved a complete response of the SCV disease after neoadjuvant chemotherapy. For patients who achieved a complete response of the SCV disease by physical examination, ultrasonography of the SCV fossa may help assess the risk of disease recurrence. SCV involvement should not be considered a contraindication for BCT.
authors.affiliation: Department of Radiation Oncology, University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Huang
authors.forename: Eric A
authors.initials: EA
authors.lastname: Strom
authors.forename: Vicente
authors.initials: V
authors.lastname: Valero
authors.forename: Bruno
authors.initials: B
authors.lastname: Fornage
authors.forename: George H
authors.initials: GH
authors.lastname: Perkins
authors.forename: Julia L
authors.initials: JL
authors.lastname: Oh
authors.forename: Tse-Kuan
authors.initials: TK
authors.lastname: Yu
authors.forename: Welela
authors.initials: W
authors.lastname: Tereffe
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Woodward
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: Aysegul A
authors.initials: AA
authors.lastname: Sahin
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
authors.forename: Gabriel N
authors.initials: GN
authors.lastname: Hortobagyi
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging / Q000379:methods; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome