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Area of Science:

  • Oncology
  • Radiation Oncology
  • Breast Cancer Research

Background:

  • Optimal local therapy for advanced breast cancer with nodal involvement in supraclavicular (SCV), internal mammary nodes (IMN), and level III axilla remains understudied.
  • Patients with advanced nodal disease often receive systemic therapy followed by radiation, but the role of nodal boosts requires further investigation.

Purpose of the Study:

  • To evaluate the outcomes of patients with breast cancer and advanced nodal disease who received adjuvant radiation with a nodal boost to the SCV, IMNs, and/or axilla.
  • To determine the efficacy and failure patterns associated with nodal boosts in this patient population.

Main Methods:

  • A retrospective study of 79 patients with advanced nodal disease and radiographic evidence of gross nodal disease post-systemic therapy.
  • Patients received adjuvant radiation with a nodal boost, and outcomes including overall survival, disease-free survival (DFS), and local recurrence-free survival (LRFS) were analyzed using Kaplan-Meier methods.

Main Results:

  • The 3-year LRFS, DFS, and overall survival rates were 94.5%, 86.3%, and 93.8%, respectively.
  • The highest failure rates (41.7%) were observed in the group receiving both IMN and axillary/SCV boosts, with no isolated locoregional failures (LRFs).
  • Combined IMN and axillary/SCV boosts were significantly associated with worse DFS (HR: 4.80; P=.02).

Conclusions:

  • In patients with locally advanced breast cancer treated with nodal boosts, most failures were distant, with no isolated locoregional recurrences.
  • The combination of internal mammary node and axillary/supraclavicular boosts was associated with the highest failure rates.
  • Further treatment escalation strategies are warranted for patients receiving combined IMN and axillary/SCV nodal boosts.