Chang, Jee Suk; Park, Won; Kim, Yong Bae; Lee, Ik Jae; Keum, Ki Chang; Lee, Chang Geol; Choi, Doo Ho; Suh, Chang-Ok; Huh, Seung Jae
International journal of radiation oncology, biology, physics
2013Aug ; 86 ( 5 ) :867-72.
PMID : 23747215
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Chang, Jee Suk -
Park, Won -
Kim, Yong Bae -
Lee, Ik Jae -
Keum, Ki Chang -
Lee, Chang Geol -
Choi, Doo Ho -
Suh, Chang-Ok -
Huh, Seung Jae -
ABSTRACT
PURPOSE: To examine the effect of internal mammary node irradiation (IMNI) on disease-free survival (DFS) and overall survival (OS) in breast cancer patients treated with modified radical mastectomy and postoperative radiation therapy. METHODS AND MATERIALS: Between 1994 and 2002, 396 patients with stage II-III breast cancer were treated with postmastectomy radiation therapy with (n=197) or without (n=199) IMNI. Patients who received neoadjuvant chemotherapy were excluded. IMNI was administered at the clinical discretion of the treating physician. Median RT dose was 50.4 Gy (range, 45.0-59.4 Gy) in 28 fractions, with inclusion of the supraclavicular fossa in 96% of patients. Adjuvant chemotherapy was administered to 99.7% of the patients and endocrine therapy to 53%.
RESULTS: The median follow-up was 149 months (range, 124-202). IMNI patients had more advanced nodal stage and non-high grade tumors than those without IMNI (P<.001). Otherwise, disease and treatment characteristics were well balanced. The 10-year DFS with and without IMNI was 65% and 57%, respectively (P=.05). Multivariate analysis demonstrated that IMNI was an independent, positive predictor of DFS (hazard ratio [HR], 0.70; P=.02). Benefits of IMNI in DFS were seen most apparently in N2 patients (HR, 0.44; 95% confidence interval [CI], 0.26-0.74) and inner/central tumors (HR, 0.55; 95% CI, 0.34-0.90). The 10-year OS with and without IMNI was 72% and 66%, respectively (P=.62). The 10-year DFS and OS were 61%, and 69%, respectively.
CONCLUSIONS: Internal mammary node irradiation significantly improved DFS in postmastectomy breast cancer patients. Pending long-term results from randomized trials, treatment of internal mammary nodes should be considered in postmastectomy radiation therapy. CI - Copyright ??2013 Elsevier Inc. All rights reserved.
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MESH
Adult, Aged, Analysis of Variance, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Axilla, Breast Neoplasms/drug therapy/*mortality/pathology/*radiotherapy/surgery, Carcinoma, Ductal, Breast/drug therapy/mortality/pathology/radiotherapy/surgery, Carcinoma, Lobular/drug therapy/mortality/pathology/radiotherapy/surgery, Chemotherapy, Adjuvant/methods, Disease-Free Survival, Female, Follow-Up Studies, Humans, Lymph Node Excision/methods, Lymphatic Irradiation/*mortality, Mastectomy, Modified Radical/methods/mortality, Middle Aged, Neoplasm Recurrence, Local/mortality/pathology, Retrospective Studies, Young Adult
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