title: Radiation treatment in pathologic n0-n1 patients treated with neoadjuvant chemotherapy followed by surgery for locally advanced breast cancer.
abstract: OBJECTIVE
  This study evaluated the treatment results and the necessity to irradiate the supraclavicular lymph node (SCN) region in pathological N0-N1 (pN0-N1) patients with locally advanced breast cancer treated with neoadjuvant chemotherapy (NAC) followed by surgery and radiotherapy (RT).
  
  
  METHODS
  Between 1996 and 2008, 184 patients with initial tumor size >5 cm or clinically positive lymph nodes were treated with NAC followed by surgery and RT. Among these patients, we retrospectively reviewed 98 patients with pN0-N1. Mastectomy was performed in 55%. The pathological lymph node stage was N0 in 49% and N1 in 51%. All patients received adjuvant RT to chest wall or breast and 56 patients (57%) also received RT to the SCN region (SCNRT).
  
  
  RESULTS
  At 5 years, locoregional recurrence (LRR)-free survival, distant metastasis-free survival, disease-free survival (DFS), and overall survival rates were 93%, 83%, 81%, and 91%, respectively. In pN0 patients, LRR was 7% in SCNRT- group and 5% in SCNRT+ group. In pN1 patients, LRR was 7% in SCNRT- group and 6% in SCNRT+ group. There was no significant difference of LRR, regardless of SCNRT. However, in pN1 patients, there were more patients with poor prognostic factors in the SCNRT+ group compared to SCNRT- group. These factors might be associated with worse DFS in the SCNRT+ group, even though RT was administered to the SCN region.
  
  
  CONCLUSIONS
  Our study showed the similar LRR, regardless of SCNRT in pN0-pN1 breast cancer patients after NAC followed by surgery. Prospective randomized trial is called for to validate the role of SCNRT.
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
authors.forename: Sun Hyun
authors.initials: SH
authors.lastname: Bae
authors.forename: Won
authors.initials: W
authors.lastname: Park
authors.forename: Seung Jae
authors.initials: SJ
authors.lastname: Huh
authors.forename: Doo Ho
authors.initials: DH
authors.lastname: Choi
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Nam
authors.forename: Young-Hyuck
authors.initials: YH
authors.lastname: Im
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Ahn
keywords: Adjuvant radiotherapy; Breast neoplasms; Lymphatic irradiation; Neoadjuvant therapy