Regional node failure in patients with four or more positive lymph nodes submitted to conservative surgery followed by radiotherapy to the breast

A retrospective analysis was conducted to evaluate the incidence of nodal f ailure in a subgroup of patients who had T1-T2 breast cancer and four or mo re positive nodes. Sixty-four 5 patients ranging in age from 29 to 73 years (median, 51) received conservative surgery followed by radiotherapy to the breast between November 1980 and May 1995. Adjuvant chemotherapy was admin istered to 56 patients, 27 of whom were also treated with tamoxifen, which was used alone in 5 patients. Three patients received no adjuvant treatment . Sixty two patients are evaluable for regional node failure. There were 10 nodal failures, 4 in the axillary and 6 in the supraclavicular regions, in 9 patients, at a median of 56.5 and 27 months, respectively. There was no internal mammary node failure. Median follow-up was 72.6 months. The 10-yea r probability of developing axillary and supraclavicular failure is 13.9 +/ - 7.7% and 10.5 +/- 4.1%, respectively. Prognosis was better for patients w ith axillary and breast recurrence and worse when relapse was in the suprac lavicular region. On the basis of our results and data already published in premenopausal patients, we believe that radiotherapy to the supraclavicula r region should be considered in patients with four or more positive axilla ry nodes, after a complete dissection.