Supraclavicular lymph-node recurrence of breast-cancer

To describe prognosis and outcome of patients with a recurrence in the supraclavicular fossa (SCLNR) and to evaluate the role of different therapeutic options for recurrence on the outcome of these patients, clinical and pathological characteristics, treatment and time course of 55 patients with supraclavicular recurrence as their first relapse of disease were analysed. Thirty-nine patients had an isolated recurrence, i.e. no distant metastases were known at the time of supraclavicular recurrence. Median follow-up was 20.4 months from supraclavicular recurrence and 58.8 months from primary diagnosis. For evaluation of treatment only the 39 patients without distant disease before or simultaneous with supraclavicular recurrence were analysed. Mean age of the 55 patients at primary diagnosis and at diagnosis of recurrence was 56.7 and 61.2 years respectively. The majority of patients developing such a recurrence was younger than 60 years at the time of primary diagnosis, Evaluation of patient characteristics showed a high proportion of positive axillary status (65%) at the time of primary diagnosis with a mean number of 7.5 involved nodes. Tumor was located in the medial or central part of the breast in 53% of patients in whom primary tumor location was known. About 80% of patients developed their recurrence in the first 5 years from primary diagnosis of breast cancer. Global survival after SCLNR was poor. Survival rate from recurrence was 65% at 2 years and only 16% at 5 years. Among the 39 patients with an isolated SCLNR 88% developed distant metastases within 5 years from recurrence. The evaluation of different therapeutic options for a SCLNR (radiotherapy, surgery, systemic therapy) revealed no significant influences on survival rates. When local regional control was obtained, a trend towards improved survival was noted. Patients aged younger than 60 years at primary diagnosis, with high positive primary axillary status or tumor of the medial or central part of the breast seem to be at higher risk for developing SCLNR and internal mammary lymphatic route may be a more probable pathway to the supraclavicular nodes besides the common axillary route. SCLNR carries a grave prognosis. Most patients develop distant disease within short time, with only a small section surviving more than 5 years from the onset of recurrence. Survival rate of patients with SCLNR is clearly inferior to patients with local or regional axillary recurrence. From this we conclude that SCLNR should be considered as an indicator of systemic disease despite its lymphogenous genesis and not as regional recurrence. Local therapy of SCLNR is to be defined with palliative intent in most cases. Systemic therapy has to be applied additionally even if no other distant disease is known. Further prospective analyses will have to evaluate the role of systemic treatment for solitary supraclavicular recurrences.