title: Outcome after conservative surgery and breast irradiation in 5,717 patients with breast cancer: implications for supraclavicular nodal irradiation.
abstract: OBJECTIVE
  To evaluate the outcome and predictive factors of patients who underwent breast-conserving surgery and adjuvant radiotherapy to the whole breast only, without supraclavicular nodal irradiation.
  
  
  METHODS
  A total of 5,717 patients with pT1-T4 breast cancer were treated at the University of Florence. The median age of the patient population was 55 years (range, 30-80 years). All patients were followed for a median of 6.8 years (range, 1-27 years). Adjuvant chemotherapy was recommended in 1,535 patients (26.9%). Tamoxifen was prescribed in 2,951 patients (51.6%). The patients were split into three groups according to number of positive axillary nodes (PAN): P1, negative axillary lymph nodes; P2, one to three PAN; P3, more than three PAN.
  
  
  RESULTS
  The P3 patients had a higher incidence of supraclavicular fossa recurrence (SFR) compared with P2 and P1 patients. However, the incidence of SFR in P3 patients was low (only 5.5%), whereas the incidence of distant metastases (DM) was 27.2%. Distant metastasis was the only independent prognostic factor for breast cancer survival. Additionally, in the subgroup of patients who developed local recurrence, DM was the most important death predictor.
  
  
  CONCLUSIONS
  Our series suggests that isolated SFR in patients who did not receive supraclavicular radiotherapy is infrequent, as well as in those patients who have more than three PAN, and SFR seems not to influence the outcome, which depends on DM occurrence.
authors.affiliation: Radiotherapy Unit, University of Florence, Viale Morgagni 85, 50134 Florence, Italy. l.livi@dfc.unifi.it
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Livi
authors.forename: Vieri
authors.initials: V
authors.lastname: Scotti
authors.forename: Calogero
authors.initials: C
authors.lastname: Saieva
authors.forename: Icro
authors.initials: I
authors.lastname: Meattini
authors.forename: Beatrice
authors.initials: B
authors.lastname: Detti
authors.forename: Gabriele
authors.initials: G
authors.lastname: Simontacchi
authors.forename: Carla Deluca
authors.initials: CD
authors.lastname: Cardillo
authors.forename: Fabiola
authors.initials: F
authors.lastname: Paiar
authors.forename: Monica
authors.initials: M
authors.lastname: Mangoni
authors.forename: Livia
authors.initials: L
authors.lastname: Marrazzo
authors.forename: Benedetta
authors.initials: B
authors.lastname: Agresti
authors.forename: Luigi
authors.initials: L
authors.lastname: Cataliotti
authors.forename: Simonetta
authors.initials: S
authors.lastname: Bianchi
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Biti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015182:Lymphatic Irradiation / Q000379:methods*; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis