Outcome After Conservative Surgery and Breast Irradiation in 5,717 Patients With Breast Cancer: Implications for Supraclavicular Nodal Irradiation
Received 26 November 2008; received in revised form 26 February 2009; accepted 2 March 2009. published online 19 June 2009.
Purpose
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 and Materials
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.
Conclusion
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.
∗Radiotherapy Unit, University of Florence, Florence, Italy
‡Department of Medical Physics, University of Florence, Florence, Italy
§Department of Surgery, University of Florence, Florence, Italy
‖Department of Pathology, University of Florence, Florence, Italy
†Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Center, Scientific Institute of Tuscany, Florence, Italy
Reprint requests to: Lorenzo Livi, M.D., Radiotherapy Unit, University of Florence, Viale Morgagni 85, 50134 Florence, Italy. Tel: (+39) 55-7947719; Fax: (+39) 55-437930
ABSTRACT