Can axillary and supraclavicular radiotherapy be avoided after breast-conserving surgery and axillary dissection in women with multiple involved axillary nodes? Experience at the European Institute of Oncology

Viviana Galimberti, Maria Cristina Leonardi, Nicole Rotmensz, Edoardo Botteri, Simona Iodice, Andrea Sagona, Rafaela Cecilio Sahium, Gulliermo Bassani, Anastasio Berrettini, Simonetta Monti, Oreste Gentilini, Claudia Sangalli, Alberto Luini, Roberto Orecchia, Umberto Veronesi

Research output: Contribution to journalArticle

Abstract

Aims and background. Although some guidelines recommend adjuvant radiotherapy (RT) to the axilla and supraclavicular nodes if 4 or more axillary nodes are involved, the current practice at our Institute is not to irradiate the axilla but to perform complete axillary dissection in which all 3 Berg levels are removed. We performed a retrospective analysis of patients with 4 or more axillary nodes involved and sufficient follow-up to provide indications as to whether our current treatment is adequate. Methods. We retrospectively analyzed 287 T1-T3 patients with a median follow-up of 5 years and 4 or more involved nodes treated by quadrantectomy and breast RT but no axillary RT; supraclavicular RT was given only when prognostic factors were unfavorable. Results. A total of 170 (59.2%) patients did not receive supraclavicular RT, while 117 (40.8%) patients received supraclavicular irradiation. No patient received axillary RT. After a median follow-up of 5 years (range, 4-105 months), 4.7% had died and 13.5% had developed distant metastases in the no supraclavicular RT group, compared to 12.0% dead (P = 0.028 log rank) and 24.8% (P = 0.201 log rank) in the supraclavicular RT group. No patients with supraclavicular RT developed supraclavicular metastases compared to 4 in the no supraclavicular RT group. There were no axillary recurrences. Conclusions. Complete axillary dissection appears adequate treatment in patients with 4 or more involved nodes. The low breast recurrence rate also suggests that breast conservation is adequate treatment in such patients. Supraclavicular RT appears to reduce the number of supraclavicular metastases but confers no survival advantage. Although a small number of cases were examined in this retrospective single-center series, all received highly uniform treatment.

Original languageEnglish
Pages (from-to)52-58
Number of pages7
JournalTumori
Volume94
Issue number1
Publication statusPublished - Jan 2008

Keywords

  • Axillary dissection
  • Axillary metastases
  • Axillary radiotherapy
  • Breast cancer
  • Supraclavicular radiotherapy

ASJC Scopus subject areas

  • Cancer Research

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