OUTCOMES OF POSITRON EMISSION TOMOGRAPHY-STAGED CLINICAL N3 BREAST CANCER TREATED WITH NEOADJUVANT CHEMOTHERAPY, SURGERY, AND RADIOTHERAPY
OUTCOMES OF POSITRON EMISSION TOMOGRAPHY-STAGED CLINICAL N3 BREAST CANCER TREATED WITH NEOADJUVANT CHEMOTHERAPY, SURGERY, AND RADIOTHERAPY
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DOI：
10.1016/j.ijrobp.2010.11.061
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发表时间：
2011-12-01
影响因子：
7
通讯作者：
Ha, Sung Whan
中科院分区：
文献类型：
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作者：
Park, Hae Jin;Shin, Kyung Hwan;Ha, Sung Whan
目的：评价临床N3 （cN3）阳性乳腺癌患者在新辅助化疗（NCT）和手术后局部淋巴结照射的治疗效果和疗效。方法和材料：回顾性分析55例初始PET扫描显示的同侧锁骨下（ICL）、内乳（IMN）或锁骨上（SCL）淋巴结累及无远处转移的患者。诊断时临床淋巴结分期（2002 AJCC）为cN3a 14例（26%），cN3b 12例（22%），cN3c 29例（53%）。所有患者均接受NCT治疗，随后进行乳房切除术或保乳手术，随后进行放射治疗（RT）。结果：在中位随访38个月（范围9-80个月）时，20例（36%）患者出现治疗失败，包括远处转移或合并局部复发，其中包括1例同侧乳房复发（IBR）， 6例局部失败（RF）和1例IBR和RF联合。只有3例（5.5%）患者在初始pet阳性临床N3淋巴结表现为治疗失败。5年局部无复发生存率、无病生存率（DFS）和总生存率分别为80%、60%和79%。在cN3b患者中，给予pet阳性IMN区域的RT和给予cN3c患者中SCL区域更高剂量（>= 55 Gy）的RT与改善5年IMN/SCL无复发生存或DFS无关。结论：对于pet阳性的cN3乳腺癌患者，NCT +手术+ RT（包括区域淋巴结）可获得良好的局部控制。该组的主要治疗失败是由于远处转移而不是射频。无论是针对pet阳性SCL淋巴结的高剂量放疗，还是pet阳性IMN淋巴结的覆盖，都与局部区域对照或DFS的额外收益无关。(C) 2011爱思唯尔公司
Purpose: To evaluate the treatment outcome and efficacy of regional lymph node irradiation after neoadjuvant chemotherapy (NCT) and surgery in positron emission tomography (PET)-positive clinical N3 (cN3) breast cancer patients.Methods and Materials: A total of 55 patients with ipsilateral infraclavicular (ICL), internal mammary (IMN), or supraclavicular (SCL) lymph node involvement in the absence of distant metastases, as revealed by an initial PET scan, were retrospectively analyzed. The clinical nodal stage at diagnosis (2002 AJCC) was cN3a in 14 patients (26%), cN3b in 12 patients (22%), and cN3c in 29 patients (53%). All patients were treated with NCT, followed by mastectomy or breast-conserving surgery and subsequent radiotherapy (RT) with curative intent.Results: At the median follow-up of 38 months (range, 9-80 months), 20 patients (36%) had developed treatment failures, including distant metastases either alone or combined with locoregional recurrences that included one ipsilateral breast recurrence (IBR), six regional failures (RF), and one case of combined IBR and RF. Only 3 patients (5.5%) exhibited treatment failure at the initial PET-positive clinical N3 lymph node. The 5-year locoregional relapse-free survival, disease-free survival (DFS), and overall survival rates were 80%, 60%, and 79%, respectively. RT delivered to PET-positive IMN regions in cN3b patients and at higher doses (>= 55 Gy) to SCL regions in cN3c patients was not associated with improved 5-year IMN/SCL relapse-free survival or DFS.Conclusion: NCT followed by surgery and RT, including the regional lymph nodes, resulted in excellent locoregional control for patients with PET-positive cN3 breast cancer. The primary treatment failure in this group was due to distant metastasis rather than RF. Neither higher-dose RT directed at PET-positive SCL nodes nor coverage of PET-positive IMN nodes was associated with additional gains in locoregional control or DFS. (C) 2011 Elsevier Inc.