Takeaway
- In breast cancer, after axillary node dissection, radiation field expansion to include the supraclavicular nodes and axillary apex yields no overall or cancer-specific survival advantage.
- Survival benefit is seen with inclusion of the internal mammary chain.
Why this matters
- Because of various difficulties, nodal irradiation often includes only the supraclavicular nodes and axillary regions, although the additional benefit their inclusion offers is unclear.
- Trials have targeted different volumes, including these nodes, the internal mammary chain, or breast or chest wall only.
Key results
- In this network meta-analysis of 4 studies, vs whole breast/chest wall irradiation alone, HRs for OS with addition of:
- Internal mammary chain: 0.88 (95% CI, 0.78-0.99; P=.036).
- Supraclavicular node/axillary apex: 0.99 (95% CI, 0.86-1.14; P=.89).
- Similar results for breast cancer-specific survival:
- Internal mammary chain added: HR, 0.82 (95% CI, 0.72-0.92; P=.002).
- Supraclavicular node/axillary apex added: HR, 0.96 (95% CI, 0.79-1.18; P=.69).
- PFS improved with addition of internal mammary chain (OR, 0.83; 95% CI, 0.71-0.97; P=.019), as did distant metastasis-free survival (HR, 0.84; 95% CI, 0.75-0.94; P=.002).
Study design
- Network meta-analysis of 4 studies (3 randomized, n=7243; 1 prospective cohort, n=3377), median follow-up, 8 years.
- Funding: None.
Limitations
- No trial included that assessed supraclavicular target alone.
- Cohort study inclusion could create bias risk.
Desafortunadamente este artículo no esta disponible para usuarios no logados
Has alcanzdo el límite de artículos por usuario
Acceso gratuito Un servicio exclusivo para profesionales sanitarios