#supraclavicular

[needyouin]

[radoncnews]

Regional nodal relapse in breast cancer patients with one to three positive axillary lymph nodes: What are the risk factors?

Supra- or infraclavicular fossa relapse (SCFR) is associated with a higher distant failure rate and subsequently results in a reduced survival. Inclusion of the infra- and supraclavicular fossae in the RT target volume increases side effects (e. g. lymphedema and pneumonitis). Therefore, supra-/infraclavicular fossa RT (SCF RT) has become the standard of care only for patients with more than 3 positive lymph nodes (LNs). Whereas the use of SCF RT in patients with 1-3 positive LNs is not consistent in Europe and America.

This retrospective analysis  (1065 patients included) aimed to identify a subgroup of breast cancer patients with 1-3LN+ who are at higher risk of SCFR such that they can be offered SCF RT at the time of diagnosis  to improve locoregional control. The overall rate of supra- or infraclavicular relapse was 9.2 %. On multivariate analysis, patients with Grade 1 cancers had a very low incidence of SCFR – regardless of how many LNs were positive. Patients with either a Grade 2 cancer and 1 or 2 positive LNs or a Grade 3 cancer and 1 positive LN had an intermediate risk of SCFR. The highest risk group consisted of patients with Grade 3 and 2-3 positive LNs or a Grade 2 cancer and 3 positive LNs. The authors conclude that high- and possibly intermediate-risk patients should be offered SCF RT in order to reduce regional relapse rates. Whether an improvement in regional control will translate into a survival benefit remains to be clarified by randomized trials.

http://www.redjournal.org/article/S0360-3016%2811%2900253-7/abstract

by CMac