Breast Cancer

PD 17 - Breast 4 -Poster Discussion

1152 - Outcome and Patterns of Failure in Breast Cancer Patients With FDG-PET Positive Internal Mammary Lymph Nodes: A Multicenter Rare Cancer Network Study

Wednesday, October 24
2:12 PM - 2:18 PM
Location: Room 217 A/B

Outcome and Patterns of Failure in Breast Cancer Patients With FDG-PET Positive Internal Mammary Lymph Nodes: A Multicenter Rare Cancer Network Study
G. Ugurluer1, M. Ozdogan2, O. Kirca2, D. C. Oksuz3, J. O. Thariat4, B. Atalar5, W. W. Wong6, M. R. Waddle7, R. C. Miller8, and M. Ozsahin9; 1Acibadem Mehmet Ali Aydinlar University, Department of Radiation Oncology, Adana, Turkey, 2Antalya Memorial Hospital, Department of Medical Oncology, Antalya, Turkey, 3Istanbul University, Cerrahpasa School of Medicine, Department of Radiation Oncology, Istanbul, Turkey, 4Centre Antoine-Lacassagne, Department of Radiation Oncology, Nice, France, 5Acibadem Mehmet Ali Aydinlar University, Department of Radiation Oncology, Istanbul, Turkey, 6Mayo Clinic Arizona, Phoenix, AZ, 7Mayo Clinic, Department of Radiation Oncology, Jacksonville, FL, 8Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, 9Centre Hospitalier Universitaire Vaudois (CHUV), Department of Radiation Oncology, Lausanne, Switzerland

Purpose/Objective(s): To assess the outcome and patterns of failure in non-metastatic operable breast cancer (NMBC) patients (pts) whose diagnostic work-up included FDG-PET and revealed positive internal mammary lymph nodes (IMLN) (with or without biopsy [bx]).

Materials/Methods: A multicenter retrospective study of 55 pts with NMBC treated between 2003 and 2015, whose diagnostic FDG-PET revealed positive IMLN, was performed in the framework of the Rare Cancer Network (RCN). Inclusion criteria were biopsy-proven NMBC, FDG-PET assessment, hormone receptor status, at least 12 months of follow-up; and exclusion criteria were age <20 or >90 years, or distant metastatic or inoperable disease.

Results: Median age was 47 years (range, 23-70) and all of the pts were female. The histopathological diagnosis was invasive ductal carcinoma in 51 pts (93%). Distribution of pts according to the clinical tumor (T) and lymph nodes (N) was; six pts T1 (11%), 36 pts T2 (65%), seven pts T3 (13%), six pts T4 (11%), 20 pts N2 (36%), and 35 pts N3 (64%). Primary tumor was located in inner quadrant in 30 pts (55%) and in superior in 42 pts (76%). There was FDG involvement in one IMLN in 31 pts, and 20 had multiple IMLN; all were ipsilateral, and IMLN SUVmax values ranged from 1.5-23.2 (median 4.95; 25% quartile 3.09). The median diameter of FDG-avid IMLN was 7 mm (range, 1-60 mm). IMLN were biopsied only in seven pts. Total mastectomy or breast-conserving surgery was performed in 42 (76%) and 13 (24%) pts, respectively, including axillary dissection in 50 (91%). Postoperative radiotherapy (median dose 50 Gy in median 25 fractions) to chest wall or breast and regional lymph nodes including IMLN was given in 53 pts (96.4%). Preoperative or postoperative chemotherapy was given in 20 (36%) and 35 pts (64%), respectively. In a median follow-up period of 104 months (range, 16-274), 48 pts were alive (7 deaths; 5 breast cancer, and 2 intercurrent disease), and 41 alive without disease. There were 13 relapses in 11 pts (2 local, 3 nodal, 8 distant). Five- and 10-year overall survival rates in all pts were 95% (95% confidence interval [CI]: 87-100%) and 93% (95% CI: %85-100); and 5- and 10-year disease-free survival (DFS) rates 83% (95% CI: 72-94%) and 71% (95% CI: 57-85%), respectively. In univariate analyses, IMLN dissection or bx did not influence DFS, while FDG-avid IMNL count (1 vs multiple; 10-year DFS 84% [95% CI: 69-99%] and 54% [95% CI: 28-80%]; p = 0.08), IMLN diameter (≤7 vs >7 mm; 10-year DFS 87% [95% CI: 73-100%] and 58% [95% CI: 30-78%]; p = 0.03), and IMLN SUVmax values (≤3 vs >3; 10-year DFS 100% and 60% [95% CI: 41-79%]; p=0.05) were factors influencing DFS. In multivariate analysis, the only independent factor for DFS was SUVmax value >3 (p = 0.025).

Conclusion: In pts with NMBC, whose diagnostic FDG-PET revealed positive IMLN, outcome does not seem to be different than those without FDG-PET assessment. However, in pts with IMLN SUVmax value >3, outcome is worse than those with SUVmax value ≤3; and prospective studies assesing more intensive treatments are warranted.

Author Disclosure: G. Ugurluer: None. M. Ozdogan: None. O. Kirca: None. J.O. Thariat: None. B. Atalar: None. W.W. Wong: Research Grant; Arizona State University. R.C. Miller: Consultant; Tekcapital, Plc, ASTRO, Belluscura Ltd. Stock; Belluscura Ltd, Tekcapital Plc. Stock Options; Belluscura Ltd, Tekcapital Plc. Vice Chair, Board of Trustees; Mayo Clinic Health System - Albert Lea/Austin. Chair, Board of Directors; Belluscura, Ltd. Non-Executive Director; Tekcapital, Plc.

Gamze Ugurluer, MD

Disclosure:
No relationships to disclose.

Presentation(s):

Send Email for Gamze Ugurluer


Assets

1152 - Outcome and Patterns of Failure in Breast Cancer Patients With FDG-PET Positive Internal Mammary Lymph Nodes: A Multicenter Rare Cancer Network Study



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Outcome and Patterns of Failure in Breast Cancer Patients With FDG-PET Positive Internal Mammary Lymph Nodes: A Multicenter Rare Cancer Network Study