Top Line: Breast cancer patients with supraclavicular nodal disease are candidates for curative treatment, but supraclavicular lymph node dissection is not commonly performed.
The Study: Does supraclavicular lymph node dissection, in addition to nodal radiation, improve control for patients with SCV lymph node metastasis from breast cancer? This retrospective study from 3 centers identified 293 patients with supraclavicular disease who received curative intent treatment. All had neoadjuvant systemic therapy, surgery for the primary tumor, axillary lymph node dissection, and adjuvant radiation. Most patients (71%) received radiation alone to the SCV while 29% had a SCV lymph node dissection. The latter were more likely treated earlier in the study period (2008-2014), more likely to have multiple positive SCV nodes, and more likely to have incomplete response to systemic therapy. Radiation fields typically covered the primary site, upper axilla, and supraclavicular fossa with only 15.7% having IMN coverage and 4.8% low axilla coverage. Patients who didn’t have SCV dissection had a higher cumulative dose to the SCV (>60 Gy v 50 Gy). At 5 years, there were no differences in SCV recurrence free survival (91.7% v 85.5%), locoregional RFS (79.1% v 73.1%), DFS (57.6% v 49.7%), or OS (71.9% v 62.2%) between those who had RT alone versus those who had RT + surgery. Four risk factors, LVI+, ER-, Ki67>30%, and axillary LN+ were associated with increased risk of recurrence. Yet, even in those with multiple risk factors, the addition of SCV dissection to RT did not improve outcomes.
TBL: This retrospective study found no improvement in recurrence or survival outcomes when patients with supraclavicular lymph node dissection was performed in addition to adjuvant nodal radiation. | Song, Radiother Oncol 2023
The Study: Does supraclavicular lymph node dissection, in addition to nodal radiation, improve control for patients with SCV lymph node metastasis from breast cancer? This retrospective study from 3 centers identified 293 patients with supraclavicular disease who received curative intent treatment. All had neoadjuvant systemic therapy, surgery for the primary tumor, axillary lymph node dissection, and adjuvant radiation. Most patients (71%) received radiation alone to the SCV while 29% had a SCV lymph node dissection. The latter were more likely treated earlier in the study period (2008-2014), more likely to have multiple positive SCV nodes, and more likely to have incomplete response to systemic therapy. Radiation fields typically covered the primary site, upper axilla, and supraclavicular fossa with only 15.7% having IMN coverage and 4.8% low axilla coverage. Patients who didn’t have SCV dissection had a higher cumulative dose to the SCV (>60 Gy v 50 Gy). At 5 years, there were no differences in SCV recurrence free survival (91.7% v 85.5%), locoregional RFS (79.1% v 73.1%), DFS (57.6% v 49.7%), or OS (71.9% v 62.2%) between those who had RT alone versus those who had RT + surgery. Four risk factors, LVI+, ER-, Ki67>30%, and axillary LN+ were associated with increased risk of recurrence. Yet, even in those with multiple risk factors, the addition of SCV dissection to RT did not improve outcomes.
TBL: This retrospective study found no improvement in recurrence or survival outcomes when patients with supraclavicular lymph node dissection was performed in addition to adjuvant nodal radiation. | Song, Radiother Oncol 2023