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Internal mammary node irradiation improves 8-year survival in breast cancer patients: results from a retrospective cohort study in real-world setting

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Abstract

Background

Regional nodal irradiation (RNI) improves disease outcome in breast cancer patients, but the contribution of internal mammary node irradiation (IMNI) in the context of modern systemic treatment is still controversial. The aim of our study is to evaluate the effect of IMNI in patients with modern systemic treatment in real-world setting.

Methods

We retrospectively analyzed patients with primary breast cancer treated with surgery followed by adjuvant chemotherapy and adjuvant chestwall/breast irradiation and RNI from 5/2007-12/2010. RNI was delivered to the ipsilateral supraclavicular region and infraclavicular region + / − IMNs. We separated two groups based on the presence and the absence of IMNI. The primary end point was disease-free survival (DFS). DFS and overall survival (OS) were evaluated with Kaplan–Meier method. Differences between two groups were compared with the log-rank test (p < 0.05 considered significant). We used two methods to account for potential confounders: propensity score matching (PSM) and Cox regression analysis.

Results

We analyzed 872 patients who received RNI with IMNI (n = 390) or without IMNI (n = 482). Median radiation dose was 50 Gy. Median follow-up was 98 months. IMNI improved 8-year DFS rates versus no IMNI: 75.9% and 64.9% (p < 0.001). After PSM, baseline characteristics were well balanced between the two groups. IMNI significantly improved DFS (p < 0.001) in patients after PSM. IMNI was an independent prognostic factor for DFS.

Conclusions

In this study, we found that IMNI improved DFS and OS in breast cancer patients in the context of modern systemic treatment. These data continue to support that IMNI is a key component of RNI.

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Abbreviations

ALND:

Axillary lymph nodes dissection

BCM:

Breast cancer mortality

BCS:

Breast-conserving surgery

CTVs:

Clinical target volumes

DFS:

Disease-free survival

DIBH:

Deep inspiration breath hold

EHR:

Electronic health records

ER:

Estrogen receptor

FISH:

Fluorescence in situ hybridization

HER-2:

Human epidermal growth factor receptor 2

HR:

Hazard ratio

IHC:

Immunohistochemistry

IMNI:

Internal mammary node irradiation

LRR:

Locoregional recurrences

MHD:

Mean heart dose

NAC:

Neoadjuvant chemotherapy

OS:

Overall survival

PMRT:

Postmastectomy radiotherapy

PR:

Progesterone receptor

PSM:

Propensity score matching

RNI:

Regional nodal irradiation

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Acknowledgements

This study was partly funded by the National Natural Science Foundation of China (Grant Number. 81602668).

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Authors and Affiliations

  1. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, 200032, China

    Xuanyi Wang, Jurui Luo, Kairui **, **ngxing Chen, Li Zhang, ** Meng, **aomeng Zhang, Zhen Zhang, **aomao Guo, Zhaozhi Yang & **aoli Yu

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China

    Xuanyi Wang, Jurui Luo, Kairui **, **ngxing Chen, Li Zhang, ** Meng, **aomeng Zhang, Zhen Zhang, Zhimin Shao, **aomao Guo, Zhaozhi Yang & **aoli Yu

  3. Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China

    Zhimin Shao

  4. Arthur G. James Cancer Hospital, The Ohio State University, Columbus, OH, 43210, USA

    Jose G. Bazan

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  1. Xuanyi Wang
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Wang, X., Luo, J., **, K. et al. Internal mammary node irradiation improves 8-year survival in breast cancer patients: results from a retrospective cohort study in real-world setting. Breast Cancer 27, 252–260 (2020). https://doi.org/10.1007/s12282-019-01015-9

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