Locally Advanced Breast Cancer Should be Treated with Intent to Cure
Breast cancer patients with spread to the ipsilateral supraclavicular lymph node (above the collarbone on the side of the body of the affected breast) should be treated with a multi-modality approach with intent to cure, according to a recent article published in the Journal of Clinical Oncology.
Patients with breast cancer that has spread to the ipsilateral supraclavicular lymph node, but with no obvious spread to other distant locations are in a unique situation in that their cancer is clinically classified as the same stage (extent of disease) as patients with evidence of distant metastases (stage IV). Since clinical staging dictates treatment options, physicians often offer this group of patients treatment selections based on the intent of prolonging survival and improving quality of life rather than the intent of achieving a cure.
Historically, the standard of care for breast cancer patients with ipsilateral supraclavicular metastasis was radiation and surgery. However, overall survival rates following this treatment modality are poor, with few patients surviving 5 years from diagnosis. Studies have suggested that a more aggressive treatment approach in this group of patients may improve upon these survival rates. To date, very few studies have been performed specifically evaluating this group of patients.
Recently, researchers from the University of Texas analyzed treatment and outcome data of 70 breast cancer patients treated at their facility between 1974 and 1999. All of these patients had ipsilateral supraclavicular lymph node involvement with no evidence of other distant metastasis. These patients were treated with an aggressive, multi-modality approach consisting of chemotherapy prior to the surgical removal of their cancer, radiation and additional chemotherapy. The overall survival rates for these patients were 41% at 5 years following treatment and 31% at 10 years following treatment. Disease-free survival rates were 34% at 5 years following treatment and 32% at 10 years following treatment.
These statistics are comparable to those of patients diagnosed with stage IIIB breast cancer who are treated with this multi-modality approach. Conversely, patients with stage IV breast cancer with distant metastases have a much poorer outcome following the same treatment approach.
Results from these analyses indicate that breast cancer patients with ipsilateral supraclavicular spread with no evidence of distant metastases should be treated as stage IIIB patients – aggressively with intent to cure. The researchers conducting this study suggest that this group of patients should be re-classified as stage IIIB, not stage IV, so physicians will adopt treatment selections based on the goal of achieving a cure.
Breast cancer patients with ipsilateral supraclavicular spread may wish to speak with their physician about the risks and benefits of aggressive treatment or the participation in a clinical trial evaluating promising new treatment strategies. Two sources of information regarding ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (cancer.gov) and eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients. (Journal of Clinical Oncology, Vol 19, No 3, pp 628-633, 2001)
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