title: Breast cancer patients with 10 or more involved axillary lymph nodes treated by multimodality therapy: influence of clinical presentation on outcome.
abstract: OBJECTIVE
  To analyze tumor control and survival for breast cancer patients with 10 or more positive lymph nodes without systemic disease, treated by adjuvant radiation alone or combined-modality therapy.
  
  
  METHODS
  We reviewed the records of 309 consecutive patients with these characteristics who received locoregional radiotherapy (RT) at our institution. The majority of patients had clinical Stage II or IIIA-B disease (43% and 48%, respectively). The median number of positive axillary lymph nodes was 15 (range, 10-78). Adjuvant therapy consisted of RT alone, with or without chemotherapy, tamoxifen, and/or ovarian castration.
  
  
  RESULTS
  The overall 5-year and 10-year disease-free survival (DFS) rates were 20% and 7%, respectively. Median DFS was higher for patients with Stage I-II compared with those with Stage IIIABC (28 vs. 19 months; p = 0.006). Median DFS for patients aged <or=35 years was lower than that of older patients (12 vs. 24 months; p < 0.0001). Patients treated with a combination therapy had a higher 5-year DFS rate compared with those treated by RT alone (26% vs. 11%; p = 0.03). In multivariate analysis, clinical stage (III vs. I, II; relative risk = 1.8, p = 0.002) and age (<or=35 vs. others; relative risk = 2.6, p <0.001) were found to be independent variables for DFS.
  
  
  CONCLUSIONS
  This retrospective data analysis identified young age and advanced clinical stage as pertinent and independent clinical prognostic factors for breast cancer patients with advanced axillary disease (10 or more involved nodes). These factors can be used for further prognostic classification.
authors.affiliation: Department of Radiation Oncology, The American University of Beirut Medical Center, Beirut, Lebanon. fg00@aub.edu.lb
authors.forename: Fady B
authors.initials: FB
authors.lastname: Geara
authors.forename: Elie
authors.initials: E
authors.lastname: Nasr
authors.forename: Susan L
authors.initials: SL
authors.lastname: Tucker
authors.forename: Maya
authors.initials: M
authors.lastname: Charafeddine
authors.forename: Bouthaina
authors.initials: B
authors.lastname: Dabaja
authors.forename: Toufic
authors.initials: T
authors.lastname: Eid
authors.forename: Jaber
authors.initials: J
authors.lastname: Abbas
authors.forename: Ziad
authors.initials: Z
authors.lastname: Salem
authors.forename: Ali
authors.initials: A
authors.lastname: Shamseddine
authors.forename: Philip
authors.initials: P
authors.lastname: Issa
authors.forename: Nagi
authors.initials: N
authors.lastname: El Saghir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012044:Regression Analysis