Long-term results of combined-modality therapy for locally advanced breastcancer with ipsilateral supraclavicular metastases: The University of Texas M.D. Anderson Cancer Center experience

Purpose: To determine outcomes in local-regional control, disease free surv ival, and overall survival in patients with locally advanced breast cancer (LABC) who present with ipsilateral supraclavicular metastases and who are treated with combined modality therapy. Patients and Methods: Seventy patients with regional stage IV LABC, which i s defined by our institution as LABC with ipsilateral supraclavicular adeno pathy without evidence of distant disease, received treatment on three pros pective trials of neoadjuvant chemotherapy. All patients received neoadjuva nt chemo therapy with cyclophosphamide, doxorubicin, and fluorourcicil, or cyclophosphamide, doxorubicin, vincristine, and prednisone. patients then r eceived local therapy that consisted of either total mastectomy and axillar y lymph node dissection (ALND) or segmental mastectomy and ALND before or a fter irradiation. Patients with no response to neoadjuvant chemotherapy wer e treated with surgery and/or radiotherapy. After completion of local thera py, chemotherapy was continued for four to 15 cycles, followed by radiother apy. Patients older than 50 years who had estrogen receptor-positive tumors received tamoxifen for 5 years. Results: Median follow-up was 11.6 years (range, 4.8 to 22.6 years). Diseas e-free survival rates at 5 and 10 years were 34% and 32%, respectively. The median disease-free survival was 1.9 years. Overall survival rates at 5 an d 10 years were 41% and 31%, respectively. The median overall survival was 3.5 years. The overall response rate (partial and complete responses) to in duction chemotherapy was 89%. No treatment-related deaths occurred. Conclusion: Patients with ipsilateral supraclavicular metastases but no oth er evidence of distant metastases warrant therapy administered with curativ e intent, ie, combined-modality therapy consisting of chemotherapy, surgery , and radiotherapy. Patients with ipsilat eral supraclavicular metastases s hould be included in the stage IIIB category of the tumor-node-metastasis c lassification because their clinical course and prognosis are similar to th ose of patients with stage IIIB LABC. (C) 2001 by American Society of Clini cal Oncology.