Postoperative periclavicular radiotherapy in breast cancer patients with 1–3 positive axillary lymph nodes

Abstract

The goal of this work was to examine the possible influence of periclavicular irradiation on outcome of breast cancer patients with 1-3 positive lymph nodes with special emphasis on late toxicity rates. Between 1997 and 2000, 235breast cancer patients (T1-2, 1-3 involved lymph nodes) were treated at our department following breast conservative surgery: 139patients (59.1%) had one, 62patients (26.4%) two, and 34patients (14.5%) three positive lymph nodes. Extracapsular spread (ECS) was described in 72patients (30.6%). There were 67patients (28.5%) who received additional radiotherapy to the ipsilateral periclavicular lymph nodes (PCLNI), while 168patients did not (noPCLNI). Patients were re-examined or contacted by phone with regard to treatment-related late effects. After a median follow-up of 78months (range 7-107months), 22patients (9.4%) developed local, 9(3.8%) axillary, 4periclavicular (1.7%), and 41distant failure (17.4%). The actuarial 8-year locoregional recurrence-free (LRRFS), disease-free (DFS), and overall survival rates (OS) were 83%, 67%, and 74%, respectively. Survival data for the PCLNI vs. noPCLNI group were 72% vs. 89% (p = 0.3), 56% vs. 73% (p = 0.4), and 86% vs. 70% (p = 0.3), respectively. No higher toxicity rates were reported in the PCLNI group compared to the noPCLNI group. We could not demonstrate any difference in outcome in breast cancer patients with 1-3 positive axillary lymph node metastases with or without periclavicular lymph node irradiation. In addition, patients with PCLNI did not complain about higher rates of late toxicities. However, patients with ECS, which may predict for locoregional failure, may benefit from adjuvant periclavicular irradiation.