Abstract
The prognosis of ipsilateral supraclavicular lymph node recurrence after early breast cancer appears to be worse than for other loco-regional recurrences, but better than for distant metastases. The purpose of the present study was to investigate the relationship between different types of salvage treatment and primary patient characteristics, treatment response, and survival after supraclavicular recurrence (SR) in a large patient population. From the Danish Breast Cancer Cooperative Group treatment database 1977–2003, 305 patients were identified with SR without distant disease as site of first recurrence. Salvage treatment types as well as other factors were related to response and survival. The median follow-up time for progression after SR was 25 months. Complete remission was 76% among patients receiving excision surgery, 67% with combined loco-regional and systemic therapy, and 48% with systemic therapy alone. Median progression-free survival (PFS) and overall survival was 18 and 29 months, respectively. The 5-year PFS probability was 15%. In univariate analysis, combination salvage therapy, negative nodal status and low malignancy grade were related to longer PFS. In multivariate analysis, salvage therapy and malignancy grade remained independent factors for survival. In conclusion, the prognosis of SR is generally poor. However, it appears to be a curable condition. An independent marker of improved outcome is local and systemic combination salvage treatment, which can be considered.
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References
Nielsen HM, Overgaard M, Grau C et al (2006) Loco-regional recurrence after mastectomy in high-risk breast cancer-risk and prognosis. An analysis of patients from the DBCG 82 b&c randomization trials. Radiother Oncol 79:147–155
Chen SC, Chang HK, Lin YC et al (2006) Prognosis of breast cancer after supraclavicular lymph node metastasis: not a distant metastasis. Ann Surg Oncol 13:1457–1465
Pergolizzi S, Settineri N, Santacaterina A et al (2001) Ipsilateral supraclavicular lymph nodes metastases from breast cancer as only site of disseminated disease. Chemotherapy alone vs. induction chemotherapy to radical radiation therapy. Ann Oncol 12:1091–1095
van der Sangen MJ, Coebergh JW, Roumen RM et al (2003) Detection, treatment, and outcome of isolated supraclavicular recurrence in 42 patients with invasive breast carcinoma. Cancer 98:11–17
Ampil FL, Caldito G, Li BD, Burton GV (2003) Supraclavicular nodal relapse of breast cancer: prevalence, palliation, and prognosis. Eur J Gynaecol Oncol 24:233–235
Moller S, Jensen MB, Ejlertsen B et al (2008) The clinical database and the treatment guidelines of the Danish Breast Cancer Cooperative Group (DBCG); its 30-years experience and future promise. Acta Oncol 47:506–524
Chen SC, Chen MF, Hwang TL et al (2002) Prediction of supraclavicular lymph node metastasis in breast carcinoma. Int J Radiat Oncol Biol Phys 52:614–619
Recht A, Gray R, Davidson NE et al (1999) Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol 17:1689–1700
Livi L, Scotti V, Saieva C et al (2010) Outcome after conservative surgery and breast irradiation in 5,717 patients with breast cancer: implications for supraclavicular nodal irradiation. Int J Radiat Oncol Biol Phys 76:978–983
Cheng JC, Cheng SH, Lin KJ et al (1998) Diagnostic thoracic-computed tomography in radiotherapy for loco-regional recurrent breast carcinoma. Int J Radiat Oncol Biol Phys 41:607–613
Waeber M, Castiglione-Gertsch M, Dietrich D et al (2003) Adjuvant therapy after excision and radiation of isolated postmastectomy locoregional breast cancer recurrence: definitive results of a phase III randomized trial (SAKK 23/82) comparing tamoxifen with observation. Ann Oncol 14:1215–1221
Haylock BJ, Coppin CM, Jackson J et al (2000) Locoregional first recurrence after mastectomy: prospective cohort studies with and without immediate chemotherapy. Int J Radiat Oncol Biol Phys 46:355–362
Fodor J, Toth J, Major T et al (1999) Incidence and time of occurrence of regional recurrence in stage I–II breast cancer: value of adjuvant irradiation. Int J Radiat Oncol Biol Phys 44:281–287
Halverson KJ, Perez CA, Kuske RR et al (1992) Survival following locoregional recurrence of breast cancer: univariate and multivariate analysis. Int J Radiat Oncol Biol Phys 23:285–291
Kiricuta IC, Willner J, Kolbl O, Bohndorf W (1994) The prognostic significance of the supraclavicular lymph node metastases in breast cancer patients. Int J Radiat Oncol Biol Phys 28:387–393
Abraham R, Nagy T, Goss PE, Crump M (2000) High dose chemotherapy and autologous blood stem cell support in women with breast carcinoma and isolated supraclavicular lymph node metastases. Cancer 88:790–795
Clemons M, Hamilton T, Mansi J et al (2003) Management of recurrent locoregional breast cancer: oncologist survey. Breast 12:328–337
Singletary SE, Allred C, Ashley P et al (2002) Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol 20:3628–3636
Pergolizzi S, Adamo V, Russi E et al (2006) Prospective multicenter study of combined treatment with chemotherapy and radiotherapy in breast cancer women with the rare clinical scenario of ipsilateral supraclavicular node recurrence without distant metastases. Int J Radiat Oncol Biol Phys 65:25–32
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An invited commentary to this article can be found at doi:10.1007/s10549-010-1067-9.
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Pedersen, A.N., Møller, S., Steffensen, K.D. et al. Supraclavicular recurrence after early breast cancer: a curable condition?. Breast Cancer Res Treat 125, 815–822 (2011). https://doi.org/10.1007/s10549-010-0918-8
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DOI: https://doi.org/10.1007/s10549-010-0918-8