title: Can axillary and supraclavicular radiotherapy be avoided after breast-conserving surgery and axillary dissection in women with multiple involved axillary nodes? Experience at the European Institute of Oncology.
abstract: OBJECTIVE
  Although some guidelines recommend adjuvant radiotherapy (RT) to the axilla and supraclavicular nodes if 4 or more axillary nodes are involved, the current practice at our Institute is not to irradiate the axilla but to perform complete axillary dissection in which all 3 Berg levels are removed. We performed a retrospective analysis of patients with 4 or more axillary nodes involved and sufficient follow-up to provide indications as to whether our current treatment is adequate.
  
  
  METHODS
  We retrospectively analyzed 287 T1-T3 patients with a median follow-up of 5 years and 4 or more involved nodes treated by quadrantectomy and breast RT but no axillary RT; supraclavicular RT was given only when prognostic factors were unfavorable.
  
  
  RESULTS
  A total of 170 (59.2%) patients did not receive supraclavicular RT, while 117 (40.8%) patients received supraclavicular irradiation. No patient received axillary RT. After a median follow-up of 5 years (range, 4-105 months), 4.7% had died and 13.5% had developed distant metastases in the no supraclavicular RT group, compared to 12.0% dead (P = 0.028 log rank) and 24.8% (P = 0.201 log rank) in the supraclavicular RT group. No patients with supraclavicular RT developed supraclavicular metastases compared to 4 in the no supraclavicular RT group. There were no axillary recurrences.
  
  
  CONCLUSIONS
  Complete axillary dissection appears adequate treatment in patients with 4 or more involved nodes. The low breast recurrence rate also suggests that breast conservation is adequate treatment in such patients. Supraclavicular RT appears to reduce the number of supraclavicular metastases but confers no survival advantage. Although a small number of cases were examined in this retrospective single-center series, all received highly uniform treatment.
authors.affiliation: Department of Senology, European Institute of Oncology, Milan, Italy. viviana.galimberti@ieo.it
authors.forename: Viviana
authors.initials: V
authors.lastname: Galimberti
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Leonardi
authors.forename: Nicole
authors.initials: N
authors.lastname: Rotmensz
authors.forename: Edoardo
authors.initials: E
authors.lastname: Botteri
authors.forename: Simona
authors.initials: S
authors.lastname: Iodice
authors.forename: Andrea
authors.initials: A
authors.lastname: Sagona
authors.forename: Rafaela Cecilio
authors.initials: RC
authors.lastname: Sahium
authors.forename: Gulliermo
authors.initials: G
authors.lastname: Bassani
authors.forename: Anastasio
authors.initials: A
authors.lastname: Berrettini
authors.forename: Simonetta
authors.initials: S
authors.lastname: Monti
authors.forename: Oreste
authors.initials: O
authors.lastname: Gentilini
authors.forename: Claudia
authors.initials: C
authors.lastname: Sangalli
authors.forename: Alberto
authors.initials: A
authors.lastname: Luini
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
authors.forename: Umberto
authors.initials: U
authors.lastname: Veronesi
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla / Q000528:radiation effects; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000556:secondary / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000556:secondary / Q000601:surgery*; D002968:Clavicle / Q000528:radiation effects; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000528:radiation effects*; D008207:Lymphatic Metastasis; D008297:Male; D015412:Mastectomy, Segmental; D008875:Middle Aged; D012189:Retrospective Studies