High dose chemotherapy and autologous blood stem cell support in women with breast carcinoma and isolated supraclavicular lymph node metastases

BACKGROUND, The prognosis of patients with isolated supraclavicular lymph n ode (SCN) metastases is similar to patients with metastatic breast carcinom a involving other sites. Because these patients have a lower disease burden compared with women with distant metastases, their outcome after high dose chemotherapy (HDCT) map be superior. METHODS. The authors evaluated event free survival (EFS) and overall surviv al in a series of 20 consecutive women with SCN metastases as the only site of metastatic disease who were treated with HDCT and peripheral blood stem cell transplantation at The Toronto Hospital. AU patients had responded to 4-6 cycles of induction CT using either an anthracycline-containing regime n or a single agent taxane, and received intensive therapy comprised of mit oxantrone, 64 mg/m(2); cyclophosphamide, 6000 mg/m(2); and carboplatin, 800 -3000 mg/m(2), each divided over 4 days followed by the infusion of autolog ous peripheral blood stem cells. involved field radiation therapy (RT) was administered when possible after transplantation to the supraclavicular fos sa and tamoxifen was given to previously untreated patients if they were ho rmone receptor positive or if their hormone receptor status was unknown. RESULTS. At a median follow-up of 28 months, 13 of the 20 women were alive, 11 of whom (55%) remained in continuous complete remission. There were no treatment-related deaths. The median overall survival was 37 months and the median progression free survival was 32 months from the dare of transplant ation. Consolidative RT was delivered to 11 women and on univariate analysi s was found to be significantly associated with better EFS (P = 0.02). CONCLUSIONS. The long term outcome of women with breast carcinoma and isola ted SCN metastases whose disease is sensitive to CT appears to be favorable ; whether this result is superior to that achieved with standard therapy al one remains to be confirmed in prospective, randomized trials. (C) 2000 Ame rican Cancer Society.