title: Supraclavicular failure after breast-conserving therapy in patients with four or more positive axillary lymph nodes when prophylactic supraclavicular irradiation is omitted.
abstract: OBJECTIVE
  The incidence of supraclavicular metastasis as the initial failure and the failure patterns in patients with four or more positive axillary lymph nodes (PALNs) after breast-conserving therapy (BCT) without prophylactic supraclavicular irradiation were investigated.
  
  
  METHODS
  Between 1991 and 2002, a total of 48 women with four or more PALNs underwent BCT without prophylactic supraclavicular irradiation (33 patients with 4-9 PALNs; 15 patients with > or =10 PALNs).
  
  
  RESULTS
  The median follow-up time was 50 months. Among the patients with 4-9 PALNs, 3% had isolated supraclavicular metastasis as the initial failure, and 30% had distant metastasis as the initial failure. Among patients with > or =10 PALNs, 7% had isolated supraclavicular metastasis as the initial failure, and 40% had distant metastasis as the initial failure. The 4-year isolated supraclavicular failure rates were 5% for all patients, 3% for patients with 4-9 PALNs, and 8% for patients with >/=10 PALNs.
  
  
  CONCLUSIONS
  In patients who had undergone BCT and had had four or more PALNs, the major failure pattern was distant failure with or without locoregional failure; isolated supraclavicular failure as the initial failure comprised a less common failure pattern. Omission of prophylactic supraclavicular irradiation may be acceptable for this subset of patients.
authors: Department of Radiology, Shikoku Cancer Center, 160 Kou, Minamiumemoto-Machi, Matsuyama 791-0280, Japan. yhamamot@shikoku-cc.go.jp
authors: Yasushi
authors: Y
authors: Hamamoto
authors: Masaaki
authors: M
authors: Kataoka
authors: Takatoshi
authors: T
authors: Semba
authors: Kotaro
authors: K
authors: Uwatsu
authors: Yoshifumi
authors: Y
authors: Sugawara
authors: Takeshi
authors: T
authors: Inoue
authors: Shinya
authors: S
authors: Sakai
authors: Shoji
authors: S
authors: Aono
authors: Tadaaki
authors: T
authors: Takahashi
authors: Shogo
authors: S
authors: Oda
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D002968:Clavicle; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012307:Risk Factors; D016019:Survival Analysis; D017211:Treatment Failure