title: Should adjuvant radiotherapy to the supraclavicular fossa be routinely given in patients with breast conservative treatment?
abstract: BACKGROUND
  To analyze the overall outcome, supraclavicular fossa (SCF) recurrence rate, and pattern of failure in breast cancer patients treated with conservative surgery and adjuvant radiotherapy excluding SCF treatment.
  
  
  METHODS
  A total of 143 patients were enrolled in the study. Ninety-two percent of patients were stages I and II, and 8% were stage III. The median age was 44 years, and 31% of patients were </=40 years old. Radiotherapy was delivered to the ipsilateral breast excluding the SCF.
  
  
  RESULTS
  The 5-year overall survival rate of the cohort was 95%, and disease-free survival rate was 91%. The cumulative incidence of SCF recurrence was 18% in patients with involved axillary nodes (N) >/= 4, and 0.8% in patients with N < 4. The 5-year SCF-recurrence-free survival in patients with N >/= 4 and N < 4 was 80% and 99%, respectively (P < 0.001). N >/= 4 was the only independent predictor for locoregional control (P = 0.045), disease-free survival (P = 0.001), and overall survival (P = 0.008) in multivariate analysis.
  
  
  CONCLUSIONS
  Women with N >/= 4 have a significantly higher risk of SCF recurrence and poorer survival. The SCF might be safely spared in patients with N < 4, but should be routinely included in the radiotherapy design for those with N >/= 4.
authors: Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Chun-Wei
authors: CW
authors: Wang
authors: Wen-Hong
authors: WH
authors: Kuo
authors: King-Jen
authors: KJ
authors: Chang
authors: Chiun-Sheng
authors: CS
authors: Huang
authors: Jason Chia-Hsien
authors: JC
authors: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001365:Axilla; D001859:Bone Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D015331:Cohort Studies; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal; D015996:Survival Rate
chemical_list: D004317:Doxorubicin