gms | German Medical Science

Purpose: There is no consensus regarding adjuvant radiotherapy of periclavicular lymph nodes in patients with limited (1-3) axillary lymph node metastases after breast conserving surgery and axillary dissection. The aim of this retrospective analysis was to evaluate the possible influence of periclavicular irradiation on outcome.

Patients and methods: 236 breast cancer patients with newly diagnosed T1/T2 tumors and 1-3 involved axillary lymph nodes received postoperative radiotherapy following breast conservative surgery between 1997 and 2000. The median age was 58 years (range, 31-84 years). The median number of resected lymph nodes was 18 (range, 3-76). Extracapsular spread (ECS) was histologically described in 60 patients (25.4%). Whole breast radiotherapy was performed in all patients (median total dose 50.4 Gy, single dose 1.8-2.0 Gy). Additionally, 68 (28.8%) patients received radiotherapy of the ipsilateral periclavicular lymph nodes (PLNI) with a median total dose of 45 Gy. Systemic adjuvant treatment was performed as follows: chemotherapy in 136 patients (57.6%) and antihormonal therapy in 193 patients (81.8%). For outcome analysis patients were divided into two treatment group depending on irradiation of the periclavicular lymph nodes (PLNI vs. no PLNI).

Results: There was a significant imbalance between the two treatment groups with more ECS positive patients receiving periclavicular irradiation (54 out of 60 patients, 90%) compared to patients without ECS (14 out of 176 patients, 7.9%, p= < 0.0001). After a median follow-up of 78 months (range, 7-107 months) 22 patients had developed local recurrence (PLNI: 7, no PLNI:15), 9 patients axillary recurrence (PLNI: 3, no PLNI: 6) and 4 patients periclavicular recurrence (PLNI: 2, no PLNI: 2). Actuarial 7-year locoregional relapse-free, metastasis-free and overall survival for all patients was 86%, 78% and 79%, respectively. The corresponding survival data for patients with vs. without PLNI were as follows: 85% vs. 87% (p = 0.27), 73% vs. 81% (p = 0.86) and 86% vs. 77% (p = 0.28), respectively.

Conclusion: In this analysis outcome of breast cancer patients with limited axillary lymph node involvement was independent of PLNI. However, because ECS may predict for locoregional failure our results cannot rule out that these patients may preferentially benefit from adjuvant periclavicular irradiation.