Prognostic significance of nodal involvement region in clinical stage IIIc breast cancer patients who received primary systemic treatment, surgery, and radiotherapy.
OBJECTIVE
To evaluate the prognostic influence of involvement of both internal mammary nodes (IMNs) and supraclavicular nodes (SCNs) in clinical stage IIIc breast cancer patients who underwent primary systemic treatment, surgery, and radiotherapy (RT).


METHODS
Between 2001 and 2009, 110 breast cancer patients with IMN or SCN involvement were treated with primary systemic treatment followed by surgery and RT. The median age was 50 years. Clinical N-stage was cN3b and cN3c in 29 (26.4%) and 81 (73.6%) patients, respectively. Among the 81 patients with cN3c disease, 18 patients had both IMN and SCN involvement. Primary systemic treatment regimen was most commonly doxorubicin plus docetaxel (54.5%) or cyclophosphamide (20.0%). Mastectomy was performed in 71 (64.5%) patients. The RT dose delivered to the chest wall or whole breast was 50-50.4 Gy in 25-28 fractions. IMN and SCN regions were irradiated in 77 (70.0%) and 107 (97.6%) patients, respectively.


RESULTS
At a median follow-up of 57.4 months (range, 8.6-149.9 months), 44 patients (40.0%) developed disease recurrence. Among the 18 patients with both IMN and SCN involvement, 12 patients experienced disease recurrence and 11 of them had distant metastases. The 5-year disease-free survival (DFS) and overall survival (OS) of all patients were 60.2% and 75.5%, respectively. Decreased DFS and OS were observed in the 18 patients with both IMN and SCN involvement (5-year rates, 33.3% and 50.0%; P = 0.0051 and 0.0010, respectively).


CONCLUSIONS
Involvement of both IMNs and SCNs was associated with worse survival outcomes in patients with clinical stage IIIc breast cancer.
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea.
Jae Myoung
JM
Noh
Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
Kyung Hwan
KH
Kim
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea. Electronic address: wonro.park@samsung.com.
Won
W
Park
Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea. Electronic address: cosuh317@yuhs.ac.
Chang Ok
CO
Suh
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea.
Seung Jae
SJ
Huh
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea.
Doo Ho
DH
Choi
Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
Ki Chang
KC
Keum
Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
Yong Bae
YB
Kim
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000556:secondary* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002968:Clavicle; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D000077143:Docetaxel; D019583:Dose Fractionation, Radiation; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D042361:Mammary Glands, Human; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage
D043823:Taxoids; D000077143:Docetaxel; D004317:Doxorubicin; D003520:Cyclophosphamide
Breast cancer; Internal mammary lymph nodes; Neoadjuvant chemotherapy; Radiotherapy; Supraclavicular lymph nodes