Strategy for treatment of isolated contralateral supraclavicular recurrence in patient with breast cancer after sentinel lymph node biopsy without axillary lymph node dissection

Abstract

Isolated ipsilateral supraclavicular (SC) lymph node recurrences of breast cancer are rare. SC recurrence is generally predictive of significant distant recurrence and rather poor prognosis. However, a curative course of systemic chemotherapy and local irradiation can be effective for patients with isolated SC recurrence, since the outcomes of patients thus treated are better than those of historical controls. This case deals with our treatment of a 44-year-old premenopausal woman with isolated contralateral SC recurrence after breast conserving surgery and sentinel lymph node (SLN) biopsy without axillary dissection for left breast cancer. The primary cancer was a triple-negative breast cancer with a tumor 7 mm in size and no metastasis in SLN. Four cycles of docetaxel and cyclophosphamide were administrated as adjuvant chemotherapy. After seven disease-free months, isolated contralateral SC lymph nodes recurred. For treatment of this recurrence, we selected eight cycles of FEC (5-fluorouracil, epirubicin, and cyclophosphamide) followed by radiation therapy for the conserved left breast and right SC fossa. Complete clinical remission has been maintained for 2 years since the recurrence. It is not known whether the treatment strategy for ipsilateral SC metastasis could have been used for our patient, but the outcome of this case suggests that systemic chemotherapy combined with local irradiation constitutes a promising option for isolated contralateral SC lymph node metastasis of breast cancer.