Venktesh, V (2011) Outcomes of combined modality therapy for breast cancer with isolated ipsilateral supraclavicular nodal metastases at presentation. Masters thesis, Cancer Institute (WIA), Chennai.
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Abstract
BACKGROUND : The female breast has been an organ of fascination and so also the treatment of breast cancer. The treatment of breast cancer has remained an enigma from the ancient past to present day .Tremendous progress has been made in the management of carcinoma breast. Despite this, the treatment is still a complex issue. Breast cancer is a major public health problem for women throughout the world. In India, breast cancer remains the most common cancer in urban women. Since 1990, the death rate from breast cancer has decreased in the United States by 24% and similar reductions have been observed in other developed countries. AIMS OF THE STUDY : 1. To determine the incidence of isolated ipsilateral supraclavicular nodal metastases at presentation, in patients with carcinoma breast. 2. To study the outcomes in response rates, disease free survival, overall survival in patients with carcinoma breast who presented with ipsilateral supraclavicular nodal metastases. 3. To determine the factors affecting the disease free survival (DFS) and overall survival (OS). MATERIALS AND METHODS : A retrospective study of patients who presented with carcinoma breast, treated at Cancer Institute (WIA) from the year 2000 to 2008 was done. The total number of patients who were diagnosed to have invasive cancer of the breast, during the study period was 5587. Of the 5587 patients, we identified 60 patients who presented with ipsilateral supraclavicular lymph nodal metastases but no evidence of other distant metastases. Patients with distant metastases other than ipsilateral supraclavicular metastases were excluded. Patients with bilateral breast cancers were also excluded. All patients underwent biopsies of the breast tumor, to document invasive carcinoma. Pretreatment evaluation consisted of a thorough history, clinical examination, contralateral mammogram, staging workup that included a chest x-ray, nuclear bone scan, ultrasound of the abdomen and pelvis. All 60 patients had metastatic supraclavicular node, diagnosed either by a fine needle aspiration cytology or an excision biopsy of the lymph node. CONCLUSION : Patients with breast cancer who present with isolated ipsilateral supraclavicular nodal metastases, though previously thought to be a subset of patients with poor prognosis and a predecessor of distant metastases, need definitive treatment with multidisciplinary approach. In our Institute, we have been practising concurrent chemotherapy and radiotherapy followed by surgery if rendered operable. The 2003 revision of the AJCC breast cancer TNM staging system has appropriately reclassified patients presenting with supraclavicular metastases from M1 to a new category IIIC. In our study, the incidence of isolated supraclavicular nodal metastases at presentation in patients with carcinoma breast was 1.07%. In our study, the 5 year overall survival and disease free survival were 31.3% and 11.7% respectively. The overall response rate (complete plus partial response) to chemoradiotherapy was 88%. About 72% of patients relapsed after the completion of chemoradiotherapy. The median time to relapse was 12 months. The most common site of relapse was distant metastases constituting about 83%. The most common site of distant metastases was lungs (44%). The median follow up duration was 30 months (range 5 – 77 months). The T stage and the clinical response to concurrent chemoradiation had a significant impact on the overall survival in multivariate analysis. Patients with ipsilateral supraclavicular nodal metastases at presentation, but with no other evidence of distant metastases have outcomes more similar to stage IIIB, rather than stage IV. Therapeutic nihilism and sequential palliative interventions alone may well be insufficient unless the patient’s performance status indicates that radical treatment will not be tolerated. The intent of treatment in this subset of patients, therefore should be curative. The definitive multidisciplinary treatment which combines chemotherapy, radiotherapy and surgery has to be the standard of care and will go a long way in improving the treatment outcomes for these patients.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | combined modality therapy ; breast cancer ; isolated ipsilateral ; supraclavicular ; nodal metastases ; presentation. |
| Subjects: | MEDICAL > Surgical Oncology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 26 Jul 2017 02:47 |
| Last Modified: | 26 Jul 2017 02:47 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2130 |
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