Prognostic Impact of Elective Supraclavicular Nodal Irradiation for Patients with N1 Breast Cancer after Lumpectomy and Anthracycline Plus Taxane-Based Chemotherapy (KROG 1418): A Multicenter Case-Controlled Study
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Purpose This study was conducted to evaluate the impact of supraclavicular lymph node radiotherapy (SCNRT) on N1 breast cancer patients receiving post-lumpectomy whole-breast irradiation (WBI) and anthracycline plus taxane-based (AT) chemotherapy. Materials and Methods We performed a case-control analysis to compare the outcomes of WBI and WBI plus SCNRT (WBI+SCNRT). Among 1,147 patients with N1 breast cancer who received post-lumpectomy radiotherapy and AT-based chemotherapy in 12 hospitals, 542 were selected after propensity score matching. Patterns of failure, disease-free survival (DFS), distant metastasis-free survival (DMFS), and treatment-related toxicity were compared between groups. Results A total of 41 patients (7.6%) were found to have recurrence. Supraclavicular lymph node (SCN) failure was detected in three patients, two in WBI and one in WBI+SCNRT. All SCN failures were found simultaneously with distant metastasis. There was no significant difference in patterns of failure or survival between groups. The 5-year DFS and DMFS for patients with WBI and WBI+SCNRT were 94.4% versus 92.6% (p=0.50) and 95.1% versus 94.5% (p=0.99), respectively. The rates of lymphedema and radiation pneumonitis were significantly higher in the WBI+SCNRT than in the WBI. Conclusion We did not find a benefit of SCNRT for N1 breast cancer patients receiving AT-based chemotherapy.
Abstract
Purpose This study was conducted to evaluate the impact of supraclavicular lymph node radiotherapy (SCNRT) on N1 breast cancer patients receiving post-lumpectomy whole-breast irradiation (WBI) and anthracycline plus taxane-based (AT) chemotherapy. Materials and Methods We performed a case-control analysis to compare the outcomes of WBI and WBI plus SCNRT (WBI+SCNRT). Among 1,147 patients with N1 breast cancer who received post-lumpectomy radiotherapy and AT-based chemotherapy in 12 hospitals, 542 were selected after propensity score matching. Patterns of failure, disease-free survival (DFS), distant metastasis-free survival (DMFS), and treatment-related toxicity were compared between groups. Results A total of 41 patients (7.6%) were found to have recurrence. Supraclavicular lymph node (SCN) failure was detected in three patients, two in WBI and one in WBI+SCNRT. All SCN failures were found simultaneously with distant metastasis. There was no significant difference in patterns of failure or survival between groups. The 5-year DFS and DMFS for patients with WBI and WBI+SCNRT were 94.4% versus 92.6% (p=0.50) and 95.1% versus 94.5% (p=0.99), respectively. The rates of lymphedema and radiation pneumonitis were significantly higher in the WBI+SCNRT than in the WBI. Conclusion We did not find a benefit of SCNRT for N1 breast cancer patients receiving AT-based chemotherapy.
참고문헌 (27)
- EBCTCG(Early Breast Cancer Trialists' Collaborative Group), "Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality : metaanalysis of individual patient data for 8135 women in 22 randomised trials", Lancet, 383, pp.2127~2135 (2014)
- Coates AS, "Tailoring therapies : improving the management of early breast cancer : St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015", Ann Oncol, 26, pp.1533~1546 (2015)
- Poortmans PM, "Internal mammary and medial supraclavicular irradiation in breast cancer", N Engl J Med, 373, pp.317~327 (2015)
- Whelan TJ, "Regional nodal irradiation in early-stage breast cancer", N Engl J Med, 373, pp.307~316 (2015)
- Mannino M, "Local relapse rates are falling after breast conserving surgery and systemic therapy for early breast cancer: can radiotherapy ever be safely withheld", Radiother Oncol, 90, pp.14~22 (2009)
- Livi L, "Loco regional failure pattern after lumpectomy and breast irradiation in 4, 185 patients with T1 and T2 breast cancer : implications for nodal irradiation", Acta Oncol, 45, pp.564~570 (2006)
- Reddy SG, "Supraclavicular nodal failure in patients with one to three positive axillary lymph nodes treated with breast conserving surgery and breast irradiation, without supraclavicular node radiation", Breast J, 13, pp.12~18 (2007)
- Galper S, "Factors associated with regional nodal failure in patients with early stage breast cancer with 0-3 positive axillary nodes following tangential irradiation alone", Int J Radiat Oncol Biol Phys, 45, pp.1157~1166 (1999)
- Yu JI, "Determining which patients require irradiation of the supraclavicular nodal area after surgery for N1 breast cancer", Int J Radiat Oncol Biol Phys, 78, pp.1135~1141 (2010)
- Yates L, "Risk factors for regional nodal relapse in breast cancer patients with one to three positive axillary nodes", Int J Radiat Oncol Biol Phys, 82, pp.2093~2103 (2012)
- Truong PT, "Patients with t1 to t2 breast cancer with one to three positive nodes have higher local and regional recurrence risks compared with node-negative patients after breast-conserving surgery and whole-breast radiotherapy", Int J Radiat Oncol Biol Phys, 73, pp.357~364 (2009)
- National Cancer Institute, "Common Terminology Criteria for Adverse Events (CTCAE) version 4.0" (2009), U.S. Department of Health and Human Services
- Xie L, "Elective regional nodal irradiation in patients with early-stage breast cancer", Semin Radiat Oncol, 21, pp.66~78 (2011)
- Jagsi R, "Progress and controversies : radiation therapy for invasive breast cancer", CA Cancer J Clin, 64, pp.135~152 (2014)
- Whelan TJ, "NCIC-CTG MA. 20: an intergroup trial of regional nodal irradiation in early breast cancer", J Clin Oncol, 29(15 Suppl), pp.LBA1003~ (2011)
- Tanis PJ, "Anatomy and physiology of lymphatic drainage of the breast from the perspective of sentinel node biopsy", J Am Coll Surg, 192, pp.399~409 (2001)
- Estourgie SH, "Lymphatic drainage patterns from the breast", Ann Surg, 239, pp.232~237 (2004)
- Belkacemi Y, "Patterns of practice of regional nodal irradiation in breast cancer : results of the European Organization for Research and Treatment of Cancer(EORTC)NOdal Radiotherapy(NORA)survey", Ann Oncol, 26, pp.529~535 (2015)
- Wai ES, "Increased use of regional radiotherapy is associated with improved outcome in a population-based cohort of women with breast cancer with 1-3 positive nodes", Radiother Oncol, 97, pp.301~306 (2010)
- Early Breast Cancer Trialists' Collaborative Group(EBCTCG), "Comparisons between different polychemotherapy regimens for early breast cancer : meta-analyses of long-term outcome among 100, 000 women in 123 randomised trials", Lancet, 379, pp.432~444 (2012)
- Qin YY, "Adjuvant chemotherapy, with or without taxanes, in early or operable breast cancer: a meta-analysis of 19 randomized trials with 30698 patients", PLoS One, 6, pp.e26946~ (2011)
- Mamounas EP, "Paclitaxel after doxorubicin plus cyclophosphamide as adjuvant chemotherapy for node-positive breast cancer : results from NSABP B-28", J Clin Oncol, 23, pp.3686~3696 (2005)
- Sartor CI, "Effect of addition of adjuvant paclitaxel on radiotherapy delivery and locoregional control of node-positive breast cancer : cancer and leukemia group B 9344", J Clin Oncol, 23, pp.30~40 (2005)
- Romond EH, "Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer", N Engl J Med, 353, pp.1673~1684 (2005)
- Cuzick J, "Statistical controversies in clinical research : longterm follow-up of clinical trials in cancer", Ann Oncol, 26, pp.2363~2366 (2015)
- Mamounas EP, "Association between the 21-gene recurrence score assay and risk of locoregional recurrence in node-negative, estrogen receptor-positive breast cancer : results from NSABP B-14 and NSABP B-20", J Clin Oncol, 28, pp.1677~1683 (2010)
- Drukker CA, "Gene expression profiling to predict the risk of locoregional recurrence in breast cancer : a pooled analysis", Breast Cancer Res Treat, 148, pp.599~613 (2014)
