Is Here any Benefit to Perform Extensive Nodal Dissection in Primary or Recurrent Forms of Breast Cancer with Supraclavicular Lymph Node Involvement?

Laurent P, Duhoux FP, Schmitz S, Fellah L, Galant C and Berliere M

Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Belgium

^*Correspondance to: Martine Berliere 

 PDF  Full Text DOI: 10.25107/2474-1647.2574

Abstract

Background: Breast oncologic surgery and especially nodal surgery has become more minimally invasive. However some aggressive breast cancers exhibit at their primary or recurrent presentation extensive nodal invasion at the axillary, retropectoralis, supraclavicular and sometimes cervical levels. Surgical treatment of these tumors is not standardized. Material and Methods: Between April 2013 and April 2018, 12 primary breast cancer patients (group I) and 5 recurrent breast cancer patients (group II) were included in a monocentric, prospective non-randomized study approved by our local ethics committee. All the patients had cytologically or histologically proven supraclavicular lymph node invasion. Six of the 12 primary tumors were triple negative and the 6 others were HER2 positive tumors. In group II, 2 were triple negative, 2 HER2 positive and one Hormone Receptor (HR) positive. All patients underwent PET/CT and breast MRI at baseline. Visceral metastases were absent in all cases. In the group of primary tumors, all the patients received neoadjuvant chemotherapy plus anti HER2 agents for HER2 positive tumors. In the group of recurrent diseases, neoadjuvant chemotherapy plus anti HER2 agents in case of HER2 positive disease was administered in 4 patients and surgery was performed first for the HR positive tumor. Radiotherapy was administered to all patients with primary tumors and cervical radiotherapy to 3 of the 5 patients with recurrent tumors. The following parameters were assessed: disease free survival, overall survival and adverse effects of surgery. Results: The median follow-up period was respectively 44 months (12-60) in group I and 42 months (12-59) in group II. In group I, 10 of the 12 included patients are still alive (although one developed signs of recurrence-a bone lesion). One patient died of metastatic evolution one year after the diagnosis and the second died of pneumonitis 3 years after the diagnosis. In group II, 3 patients are still alive with no signs of recurrence and 2 died of metastatic evolution, respectively 24 and 28 months after recurrence. Concerning side effects, no persistent chronic pain, or motor deficits are noted. Lymphedema is present in 4 of the 13 patients still alive. Discussion: Patients with nodal metastases outside the axilla seem to benefit from extensive surgery integrated in a multidisciplinary therapeutic approach. Some studies have demonstrated survival benefits for patients undergoing surgical resection of these nodes. Conclusion: In breast tumors (especially HER2 positive and triple negative tumors) presenting with extensive supraclavicular nodal invasion and no visceral metastases, surgical excision can be integrated in the multidisciplinary approach for patients responding to neoadjuvant treatments. Patients need to be followed for a long time to confirm survival benefits.

Keywords

Breast Cancer; Lymph Node; Tumors

Cite the article

Laurent P, Duhoux FP, Schmitz S, Fellah L, Galant C, Berliere M. Is Here any Benefit to Perform Extensive Nodal Dissection in Primary or Recurrent Forms of Breast Cancer with Supraclavicular Lymph Node Involvement?. Clin Surg. 2019; 4: 2574..