Clinical Outcomes After Post-operative Radiotherapy for Breast Cancer Patients Presenting with Ipsilateral Supraclavicular Metastasis: Considerations on the Cranial Border of Irradiation Field

Overview

Journal Breast Cancer

Specialty Oncology

Date 2024 Oct 23

PMID 39441499

Authors

Xiaofang Wang

Xiaomeng Zhang

Li Zhang

Jin Meng

Wei Shi

Xingxing Chen

Zhaozhi Yang

Xin Mei

Xiaoli Yu

Zhen Zhang

Zhimin Shao

Xiaomao Guo

Jinli Ma

Affiliations

Soon will be listed here.

Abstract

Background: Disease recurrence at lower neck adjacent to ipsilateral supraclavicular (SCV) region represents a concern in locally advanced breast cancer patients presenting with SCV metastasis at diagnosis. This study aims to report the outcomes following post-operative radical radiation therapy and discuss the reasonable cranial border of the irradiation field for N3c patients.

Methods: Between July 2016 and January 2022, a total of 268 patients were eligible for analysis. The endpoints included in-field and out-field cervical failures, local-regional recurrence-free survival (LRRFS), SCV recurrence-free survival (SRFS), distant metastasis-free survival (DMFS), relapse-free survival (RFS), and overall survival (OS).

Results: During a median follow-up of 37 months (range 3-89 months), 17 patients (6.3%) developed local-regional recurrence as the first recurrence event, with 13 having concomitant distant-metastasis (DM); 56 patients (20.9%) had DM alone. The 3-year rates of LRRFS, SRF, DMFS, RFS, and OS were 92.3%, 94.5%, 74.5%, 73.0%, and 90.0%, respectively. 89.2% of patients received RT with the cranial border at the top of hyoid bone, and 95.1% of patients received a boost not exceeding the level of cricoid cartilage. A total of 11 patients (4.1%) developed ipsilateral SCV failure, and 3 patients (1.1%) experienced cervical failure, including 2 in-field failures and 1 out-field failure. Neoadjuvant systemic therapy (NST) was administered to 234 patients (87.3%). In the multivariate analysis, non-ypN0, triple-negative subtype and cT4 at diagnosis were predictors of worse SRFS and RFS in NST subgroup.

Conclusion: Our findings suggest that radical RT with cranial border of irradiation field at the hyoid bone level lead to excellent local-regional control, and out-field cervical failure was rare. The irradiation field might not extend to mastoid process.

References

Giuliano A, Edge S, Hortobagyi G . Eighth Edition of the AJCC Cancer Staging Manual: Breast Cancer. Ann Surg Oncol. 2018; 25(7):1783-1785. DOI: 10.1245/s10434-018-6486-6. View

Brito R, Valero V, Buzdar A, Booser D, Ames F, Strom E . Long-term results of combined-modality therapy for locally advanced breast cancer with ipsilateral supraclavicular metastases: The University of Texas M.D. Anderson Cancer Center experience. J Clin Oncol. 2001; 19(3):628-33. DOI: 10.1200/JCO.2001.19.3.628. View

Huang E, Strom E, Valero V, Fornage B, Perkins G, Oh J . Locoregional treatment outcomes for breast cancer patients with ipsilateral supraclavicular metastases at diagnosis. Int J Radiat Oncol Biol Phys. 2007; 67(2):490-6. DOI: 10.1016/j.ijrobp.2006.08.040. View

Kim K, Jeong Y, Shin K, Kim J, Ahn S, Kim S . Impact of Regional Nodal Irradiation for Breast Cancer Patients with Supraclavicular and/or Internal Mammary Lymph Node Involvement: A Multicenter, Retrospective Study (KROG 16-14). Cancer Res Treat. 2019; 51(4):1500-1508. PMC: 6790841. DOI: 10.4143/crt.2018.575. View

Masuda N, Lee S, Ohtani S, Im Y, Lee E, Yokota I . Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy. N Engl J Med. 2017; 376(22):2147-2159. DOI: 10.1056/NEJMoa1612645. View

Loganadane G, Truong P, Taghian A, Tesanovic D, Jiang M, Geara F . Comparison of Nodal Target Volume Definition in Breast Cancer Radiation Therapy According to RTOG Versus ESTRO Atlases: A Practical Review From the TransAtlantic Radiation Oncology Network (TRONE). Int J Radiat Oncol Biol Phys. 2020; 107(3):437-448. DOI: 10.1016/j.ijrobp.2020.04.012. View

Hammond M, Hayes D, Dowsett M, Allred D, Hagerty K, Badve S . American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010; 28(16):2784-95. PMC: 2881855. DOI: 10.1200/JCO.2009.25.6529. View

Wolff A, Hammond M, Allison K, Harvey B, Mangu P, Bartlett J . Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. J Clin Oncol. 2018; 36(20):2105-2122. DOI: 10.1200/JCO.2018.77.8738. View

Ai X, Wang M, Li J, Hu Y, Hou L, Zheng X . Supraclavicular lymph node dissection with radiotherapy versus radiotherapy alone for operable breast cancer with synchronous ipsilateral supraclavicular lymph node metastases: a real-world cohort study. Gland Surg. 2020; 9(2):329-341. PMC: 7225486. DOI: 10.21037/gs.2020.03.09. View

10.

Song Y, Kong J, Li N, Liu X, Li X, Zhu L . Comparison of supraclavicular surgery plus radiotherapy versus radiotherapy alone in breast cancer patients with synchronous ipsilateral supraclavicular lymph node metastasis: A multicenter retrospective study. Radiother Oncol. 2023; 183:109639. DOI: 10.1016/j.radonc.2023.109639. View

11.

Chang X, Yin J, Sun J, Zhang X, Cao X . A retrospective study of different local treatments in breast cancer patients with synchronous ipsilateral supraclavicular lymph node metastasis. J Cancer Res Ther. 2014; 9 Suppl:S158-61. DOI: 10.4103/0973-1482.122514. View

12.

Gradishar W, Moran M, Abraham J, Abramson V, Aft R, Agnese D . NCCN Guidelines® Insights: Breast Cancer, Version 4.2023. J Natl Compr Canc Netw. 2023; 21(6):594-608. DOI: 10.6004/jnccn.2023.0031. View

12.

von Minckwitz G, Huang C, Mano M, Loibl S, Mamounas E, Untch M . Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer. N Engl J Med. 2018; 380(7):617-628. DOI: 10.1056/NEJMoa1814017. View

13.

Park H, Shin K, Cho K, Park I, Lee K, Ro J . Outcomes of positron emission tomography-staged clinical N3 breast cancer treated with neoadjuvant chemotherapy, surgery, and radiotherapy. Int J Radiat Oncol Biol Phys. 2011; 81(5):e689-95. DOI: 10.1016/j.ijrobp.2010.11.061. View

14.

Diao K, Andring L, Barcenas C, Singh P, Carisa Le-Petross H, Reed V . Contemporary Outcomes After Multimodality Therapy in Patients With Breast Cancer Presenting With Ipsilateral Supraclavicular Node Involvement. Int J Radiat Oncol Biol Phys. 2021; 112(1):66-74. PMC: 8688264. DOI: 10.1016/j.ijrobp.2021.08.026. View

15.

Jin K, Luo J, Wang X, Yang Z, Zhang L, Mei X . Symptoms Related to Brachial Plexus Neuropathy After Supraclavicular Irradiation and Boost in Breast Cancer. Pract Radiat Oncol. 2021; 12(1):e13-e23. DOI: 10.1016/j.prro.2021.08.003. View

16.

Brown L, Diehn F, Boughey J, Childs S, Park S, Yan E . Delineation of Supraclavicular Target Volumes in Breast Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys. 2015; 92(3):642-9. DOI: 10.1016/j.ijrobp.2015.02.022. View

17.

Jing H, Wang S, Li J, Xue M, Xiong Z, Jin J . Mapping Patterns of Ipsilateral Supraclavicular Nodal Metastases in Breast Cancer: Rethinking the Clinical Target Volume for High-risk Patients. Int J Radiat Oncol Biol Phys. 2015; 93(2):268-76. DOI: 10.1016/j.ijrobp.2015.08.022. View

18.

Li L, Zhang H, Wang L, Xie C, Yu H, Zhong Y . Optimization of supraclavicular lymph node clinical target volume delineation in high-risk breast cancer: a single center experience and recommendation. BMC Cancer. 2023; 23(1):1168. PMC: 10688076. DOI: 10.1186/s12885-023-11596-6. View

19.

Offersen B, Boersma L, Kirkove C, Hol S, Aznar M, Sola A . ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol. 2015; 114(1):3-10. DOI: 10.1016/j.radonc.2014.11.030. View