title: Long-term outcomes among breast cancer patients with extensive regional lymph node involvement: implications for locoregional management.
abstract: Extensive lymph node (LN) involvement portends significant risk for distant metastasis (DM) among breast cancer patients. As a result, local management may be of secondary import to systemic control in this population. We analyzed patients with ≥10 involved LNs (N3) to evaluate the feasibility of breast conserving therapy (BCT) vs modified radical mastectomy (MRM) in this high-risk cohort. Among 98 women with N3 disease 46 (46.9%) underwent BCT and 52 (53.1%) received MRM. Nearly all patients (92%) received comprehensive radiotherapy (RT) including axillary and supraclavicular fields. The Kaplan-Meier method and Cox regression analyses were used to analyze time-to-event outcomes. Median follow-up was 76 months, with a 5-year DFS of 64.9% and OS of 71.9% among the cohort. Poorly differentiated (p = 0.007), ER-negative tumors (p = 0.015) had adverse DFS outcomes. Treatment groups did not differ with regard to 10-year DFS (45.4% for MRM vs. 57.6% for BCT; p = 0.31), or OS (61.4 vs. 63.7%; p = 0.79). DM-free survival was 48.9% following MRM and 60.6% following BCT (p = 0.19). Patients with ≥10 involved LNs have similar outcomes following BCT or MRM, suggesting that RT may obviate the need for more-extensive surgery. While local control is comparably favorable regardless of surgical approach, systemic control remains a challenge in this population.
authors.affiliation: Harvard Radiation Oncology Program, Boston, MA, USA. lbraunstein@partners.org.
authors.forename: Lior Z
authors.initials: LZ
authors.lastname: Braunstein
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Boston, MA, 02114, USA.
authors.forename: Sigolene
authors.initials: S
authors.lastname: Galland-Girodet
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Boston, MA, 02114, USA.
authors.forename: Saveli
authors.initials: S
authors.lastname: Goldberg
authors.affiliation: Harvard Radiation Oncology Program, Boston, MA, USA.
authors.forename: Laura E G
authors.initials: LE
authors.lastname: Warren
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Boston, MA, 02114, USA.
authors.forename: Betro T
authors.initials: BT
authors.lastname: Sadek
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Boston, MA, 02114, USA.
authors.forename: Mina N
authors.initials: MN
authors.lastname: Shenouda
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Boston, MA, 02114, USA.
authors.forename: Rita F
authors.initials: RF
authors.lastname: Abi-Raad
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Boston, MA, 02114, USA.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: MacDonald
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Boston, MA, 02114, USA. ataghian@mgh.harvard.edu.
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D016016:Proportional Hazards Models; D012044:Regression Analysis; D016896:Treatment Outcome
keywords: Breast cancer; Lumpectomy; Mastectomy; Radiotherapy; Recurrence