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Abstract
INTRODUCTION:
The purpose of this study was to evaluate the outcomes of upfront surgery followed by radiation therapy (RT) for ipsilateral supraclavicular (SCN) and/or internal mammary (IMN) node-positive breast cancer.

MATERIALS AND METHODS:
One hundred fifty-eight patients were included; among these, 91 patients were SCN-positive, 54 were IMN-positive, and 13 were SCN- and IMN-positive. Patients underwent breast conserving surgery (n = 74) or mastectomy (n = 84) followed by systemic therapy, and adjuvant RT to whole breast/chest wall with or without regional nodal RT. Regarding regional treatments for SCN and IMN, SCN excision was performed in 59 (37.3%) patients, IMN excision in 10 (6.3%) patients, SCN RT in 143 (90.5%) patients, and IMN RT in 68 (43.0%) patients.

RESULTS:
The median duration of follow-up was 72 months (range, 7-182 months). There were 20 locoregional recurrences and 45 distant metastases. In-field failure was observed only in SCN (n = 8), and 6 of these patients initially underwent SCN excision. The 5-year locoregional recurrence-free survival, disease-free survival (DFS), and overall survival rates were 87.3%, 71.6%, and 89.7%, respectively. Neither SCN excision nor SCN RT dose ≥ 54 Gy improved locoregional control (P = .927 and P = .693, respectively) or DFS (P = .394 and P = .686, respectively). Having ≥ 10 involved axillary lymph nodes was the only independent prognosticator for DFS after adjusting for covariates (P = .003).

CONCLUSION:
Regional control rate in initially involved SCN and/or IMN was acceptable in patients treated with upfront surgery followed by systemic therapy plus adjuvant RT. More aggressive regional therapy such as SCN excision did not improve locoregional control or survival.

Author information

Kim K1, Kim SS2, Shin KH3, Kim JH4, Ahn SD2, Choi DH5, Park W5, Lee SY6, Chun M7, Kim JH8, Kim YB9, Cha J10, Park HJ11, Lee DS12, Jung W1.
1
Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
2
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
3
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: radiat@snu.ac.kr.
4
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
5
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
6
Department of Radiation Oncology, Chonbuk National University Hospital, Jeonju, Republic of Korea.
7
Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea.
8
Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.
9
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
10
Department of Radiation Oncology, Wonju Severance Christian Hospital, Wonju, Republic of Korea.
11
Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Republic of Korea.
12
Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea.