fullofbeans--this one is for you! from ASCO

[Lani]

these authors feel supraclavicular metastasis should be lumped with axillary metastasis and reflect advanced disease but not distant metastasis in terms of prognosis (ie, better) and found an almost two-fold improvement in survival if they took the nodes out. One caveat--it seems all their studies were ipsilateral ie, none bilateral, but still it sounds promising.

if you judt let them just irradiate you will never know what you are fighting and what best to fight it with and you will deprive yourself of the results of this report ie, surgical removal does help prognosis.

Hope this helps!!

PS I tried to find the poster presenter to ask questions, but failed.

Also, do not let the stats freak you out as yours is her2+ breast cancer, an entirely different animal and they are developing more and more effective treatments against it all the time.


Survival benefit of neck dissection for patients with breast cancer with supraclavicular lymph node metastasis.

Sub-category: Metastatic Breast Cancer

Category: Breast Cancer - Metastatic Breast Cancer

Meeting: 2010 ASCO Annual Meeting


Citation: J Clin Oncol 28:7s, 2010 (suppl; abstr 1069)

Abstract No: 1069


Attend this session at the ASCO Annual Meeting!
Session: Breast Cancer - Metastatic

Type: General Poster Session

Time: Saturday June 5, 2:00 PM to 6:00 PM

Location: S Hall A2

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Author(s): S. Chen; Chang Gung Memorial Hospital, Taipei, Taiwan


Abstract:

Background: The incidence and outcome of supraclavicular lymph node metastasis (SLNM) were poorly defined for it had been combined with axillary relapse as regional nodal failure in the literatures, and further surgical treatment for the regional nodal relapse had never been evaluated. Methods: A total of 5,409 consecutive women with primary breast cancer who received surgical treatment in the single institute from 1990 to 2003 were included in the study. Isolated chest wall recurrence as first event was defined as local relapse. SLNM was defined as only isolated ipsilateral site neck nodal recurrence. All SLNM had tissue proof. Neck dissection defined as curative intent to remove all nodes and soft tissue in neck level IV and part of III and V, incisional or excisional biopsy of neck node were not included. Median follow up was 84 months. Results: There were 271 patients (5.0%) developed local relapse and 127 patients (2.3%) suffered from SLNM. Forty-nine in 127 SLNM patients had received neck dissection. There were no significant differences of age distribution, initial tumor size, axillary nodal involvement, estrogen and progesterone receptor, HER2/neu status, level II dissection, adjuvant chemotherapy, hormonal therapy, and radiotherapy between the two groups of neck dissection or not. The 5, 10 years overall survival (OS) for local relapse, SLNM and distant metastasis were, 38.7%, 26.1%; 21%, 9.2%, and 13.8%, 7.0%, respectively. The 5, 10 years OS for those received neck dissection or not were 30.6%, 16.1%, and 14.9% 4.7% (p=0.002); the 5, 10 years distant metastasis-free survival were 16.3%, 8.2%, and 8.5, 3.8%, respectively (p=0.004). In multivariate analysis, neck dissection, disease-free interval, and hormonal therapy were independent prognostic factor for survival, the hazard ratio, 95% confidence interval were 1.715 (1.165 ~ 2.524), 1.473 (1.016 ~ 2.137) and 1.490 (1.023 ~ 2.169), respectively. Conclusions: Isolated SLNM should not consider as distant metastasis, and aggressive surgery is benefit for patients.