supraclavicular nodal failure after surgery in n1 breast cancer patients without supraclavicular irradiation

Background: we conducted a retrospective analysis to evaluate the impact ofomission of supraclavicular radiotherapy on supraclavicular failure rate and treatmentoutcomes in n1 breast cancer patients with evaluation of prognostic factors thataffected supraclavicular recurrence free survival.methods: this study analyzed the medical records of 109 patients with n1 breastcancer. all patients underwent surgery and received adjuvant chemotherapy withoutsupraclavicular radiotherapy. supraclavicular recurrence free survival, distant metastasisfree survival, disease free survival, and overall survival were estimated using thekaplan-meier method and compared using log-rank analysis.results:after a median follow up period of 58 months, treatment failed in 31 patients(28.4%); patterns of failure consisted of locoregional (n=21, 19.3%), isolated supraclavicular(n=7, 6.4%), and distant metastasis (n=14, 12.8%). survival rates at 5 yearswere as follows: supraclavicular recurrence free survival (84.9%), distant metastasisfree survival (87.6%), and overall survival (86.4%). univariate analysis revealed thatthe type of chemotherapeutic regimen was the only significant prognostic factoraffected supraclavicular recurrence free survival; patients who received the cyclophosphamide,methotrexate, 5-fluorouracil chemotherapy regimen experienced lowersupraclavicular recurrence free survival than those who received doxorubicin based andtaxane based chemotherapy. development of supraclavicular recurrence significantlylowered the 5-year overall survival (57.1%) and distant metastasis free survival (50%)rates compared to patients without supraclavicular recurrence who had an overallsurvival rate of 88.5% (p < 0.0001) and distant metastasis free survival rate of 90%(p < 0.0001).conclusion: patients with n1 breast cancer had an overall supraclavicular recurrenceof 6.4% which denoted that additional supraclavicular radiotherapy was unnecessaryand could be given in n1 patients after surgery and an adjuvant cmf regimen. aprospective randomized trial would be needed to clarify the impact of supraclavicularradiotherapy on treatment outcome.