| Objective:To evaluate the supraclavicular nodal failure(SCF) of the breast cancer patients with one to three positive axillary nodes treated with breast conserving surgery and to identify the risk factors for SCF.Methods:256 breast cancer patients with one to three positive axillary nodes treated with breast conserving surgery and axillary dissection without neoadjuvant systemic therapy from Jan.2001 to Mar.2014 were analyzed. All patients received whole breast radiation to a total dose of 46-50 Gy (median 50 Gy) at 2 Gy/f or 43.5 Gy at 2.9 Gy/f. Tumor bed was boosted to 50-70 Gy (median 60 Gy) at 2 Gy/f or 52.2 Gy at 2.9 Gy/f. No patient received regional nodal radiation.245 (95.7%) patients received adjuvant chemotherapy.200(99.5%) ER/PR positive patients received hormonal therapy.The SCF, LRR, DM and OS rates were calculated by Kaplan-Meier method and compared by the Logrank test.Results:The 5-year SCF, LRR, DM and OS rates were 2.1%,2.1%,5%,98%, respectively. LVI,2 to 3 positive axillary nodes and Luminal B tumor type are risk factors for SCF. The 5-year SCF rate was 5.3% for patients with 2-3 positive axillary nodes and 2.8% for those with 1 positive node (P= 0.010); 5.3% and 1.8% for those LVI positive and negative (P= 0.030); 7.1%,3.2%,1.2% and 0% for Luminal B, Basal, Luminal A and Her-2 positive tumor type (P= 0.006). Patients with 0,1 and 2-3 risk factors had 5 year SCF rates of 0%,3.0% and 10.6%(P< 0.001).Conclusion:The supraclavicular nodal recurrence rate is very low for breast cancer patients with one to three positive axillary nodes treated with breast conserving surgery without supraclavicular nodal radiation, indicating that prophylactic supraclavicular nodal RT is not necessary for all patients. We recommend prophylactic supraclavicular nodal RT for patients with 2-3 risk factors.Further study with large samples and longer follow up for validation is warranted. |
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