Abstract
BackgroundThis study aimed to determine the optimal radiotherapy (RT) regimen for patients with clinical metastasis to the internal mammary lymph node (cIMN+) from breast cancer.MethodsWe retrospectively reviewed the medical records of 84 patients with cIMN+ breast cancer treated with curative surgery, taxane-based chemotherapy, and postoperative RT between January 2009 and December 2014. Postoperative RT was administered to the whole breast or chest wall using 50 Gy in 2 Gy fractions. Boost RT to the internal mammary lymph node (IMN) was administered at the physician’s discretion. We categorized patients into two groups according to the IMN dose as follows: low-dose IMN RT (50.0–63.5 Gy) and high-dose IMN RT (63.6–70.4 Gy).ResultsAfter a median follow-up of 58 months (range, 12–111 months), IMN recurrence was observed in 2 patients (2.4%), and all IMN recurrences developed simultaneously with distant metastases. The 5-year locoregional recurrence-free survival, disease-free survival (DFS), and overall survival rates were 89.1, 72.0, and 81.2%, respectively. The triple-negative subtype, IMN size ≥1.0 cm, old age, and low-dose IMN were significantly associated with poor DFS. Among the patients with IMN size ≥1.0 cm, the 5-year DFS was significantly higher in those treated with high-dose IMN RT than in those treated with low-dose IMN RT (69.3% vs. 33.3%, p = 0.019).ConclusionsIMN RT without IMN dissection resulted in favorable outcomes in cIMN+ breast cancer. For patients with a large IMN, a higher IMN radiation dose might be needed for disease control.
Highlights
Internal mammary node (IMN) involvement is a known poor prognostic factor for survival in patients with breast cancer
We retrospectively reviewed medical records of patients who received postoperative RT for cIMN+ breast cancer at the Samsung Medical Center between January 2009 and December 2014. cIMN+ was defined as the IMN size of ≥0.5 cm on imaging studies at the time of breast cancer diagnosis
Breast US, chest computed tomography (CT), and positron emission tomography-computed tomography (PET-CT) were performed for 83 patients, 67 patients, and 72 patients, respectively
Summary
Internal mammary node (IMN) involvement is a known poor prognostic factor for survival in patients with breast cancer. Patients with clinical IMN involvement (cIMN+) had a low survival rate with frequent distant metastasis compared to those without cIMN+ [1]. In recent years, multimodal treatments including breast surgery without IMN dissection, systemic therapy, and radiotherapy (RT) have been administered for patients with cIMN+ breast cancer. With these multimodal treatments, favorable outcomes could be achieved for cIMN+ breast cancer [4, 6]. To. This study aimed to determine the optimal radiotherapy (RT) regimen for patients with clinical metastasis to the internal mammary lymph node (cIMN+) from breast cancer
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