Incidence and time of occurrence of regional recurrence in stage I-II breast cancer:: Value of adjuvant irradiation

Purpose: The value of adjuvant radiation therapy (RT) of the axilla and supraclavicular fossa is controversial in early-stage breast cancer. This retrospective study was undertaken to identify pathological risk factors that would predict which subsets of patients would benefit from regional nodal irradiation (RNI), Methods and Materials: A total of 1309 women with Stage VII breast cancer under,vent full axillary dissection and either mastectomy (n = 894) or breast-conserving surgery (n = 415), Of these, 712 patients received RNI, The median axilla/supraclavicular fossa dose was 50 Gy, Results: The 10-year actuarial rate of axillary failure (AXF) was 0.5% in N0 and 2.8% in N1 patients (p 0.0014), The number of retrieved nodes, less than or equal to 5 vs. > 5, also correlated with AXF; the respective rate was 4.3% vs. 1.2% (p = 0.0142), Neither the incidence of,AXF nor the time to AXF was affected significantly by the use of RNI, but in N1 patients with retrieved nodes I 5, the rate of AXF was 8.3% without RNI vs. 0% with RNI (p = 0.2340), The 10-year actuarial rate of supraclavicular failure (SCF) was 1.2% in N0 and 6.3% in N1 patients (p ;0.0000), SCF was also associated with the extent of nodal involvement (p = 0.0031), The incidence of SCF was not significantly affected by the use of RNI, However, when the results of N1bii and N1biv patients were evaluated as a single group, the effect of RNI was significant (p = 0.0358), The rates of SCF without RNI were high in patients with N1bii or N1biv stage: 10% and 37.5% and, with RNI, 3.2% and 18.2%, respectively, These findings were reinforced by the various combinations of T- and N1-stage, The mean time to SCF was 53.6 months in the irradiated and 24.9 months in the nonirradiated patients (p = 0.0007). Conclusions: After a complete axillary dissection, only N1 patients with retrieved nodes less than or equal to 5 may be considered for axillary RT, Elective supraclavicular RT is suggested for patients with N1bii or N1biv stage. Supraclavicular irradiation decreases the incidence and delays the appearance of SCF. (C) 1999 Elsevier Science Inc.