Entire versus Medial Supraclavicular Nodal Irradiation for Patients with High-risk Node-positive Breast Cancer
Menée à l'aide de données 2015-2016 portant sur 544 patientes atteintes d'un cancer du sein à haut risque avec atteinte ganglionnaire (durée médiane de suivi : 64,2 ans), cette étude analyse l'efficacité, du point de vue de la survie sans récidive et de la survie globale, d'une irradiation des aires ganglionnaires en fonction de son étendue
Purpose: We aimed to examine whether elective inclusion of the posterolateral supraclavicular node (SCL) region to the standard medial SCL target volume improves SCL control and survival outcomes in patients with high-risk node-positive breast cancer undergoing regional nodal irradiation (RNI). Methods and Materials: We retrospectively reviewed 544 consecutive women with high-risk breast cancer treated with postoperative chest wall/breast and RNI in our center from 1/2015-12/2016. High-risk features were defined as clinical or pathological stage N2-3b disease. Patients were classified into the medial SCL irradiation (M-SCLI) group and the entire SCL irradiation (E-SCLI) group, which included both medial and posterolateral SCL region. SCL recurrence (SCLR), Disease-free survival (DFS), and overall survival (OS) was estimated and compared. Propensity-score matching (PSM) and multivariate cox regression were used for analysis. Results: The median follow-up time is 64.2 months. Before PSM, there was no significant difference in the cumulative incidence of SCLR between the two groups, with 5-year rates of 2.0% in the M-SCLI group and 0.6% in the E-SCLI group (P=0.1). After PSM, there was also no significant difference in the cumulative incidence of SCLR (2.1% vs. 0.5%; P=0.2). Only 2 patients had recurrence in the posterolateral SCL region, with 1 patient in each group. Similarly, there was no significant difference in DFS and OS between the M-SCLI and E-SCLI group both before PSM (5-year rates of 78.5% vs. 78.8%, P=0.8; 92.2% vs. 90.0%, P=0.2) and after PSM (76.7% vs. 77.2%, P=0.8; 91.5% vs. 88.4%, P=0.1). Multivariate analysis demonstrated that E-SCLI was not independently prognostic for DFS and OS. Conclusions: E-SCLI does not appear to be associated with improved SCL control and survival outcomes in high-risk node-positive breast cancer. These data do not support the routine use of E-SCLI in N2-3b disease. We initiated a multicenter randomized controlled phase III study comparing M-SCLI versus E-SCLI to further validate these results.
International Journal of Radiation Oncology, Biology, Physics 2022