Breast Cancer Research and Treatment

, Volume 154, Issue 3, pp 633–639 | Cite as

Long-term outcomes among breast cancer patients with extensive regional lymph node involvement: implications for locoregional management

  • Lior Z. Braunstein
  • Sigolene Galland-Girodet
  • Saveli Goldberg
  • Laura E. G. Warren
  • Betro T. Sadek
  • Mina N. Shenouda
  • Rita F. Abi-Raad
  • Shannon M. MacDonald
  • Alphonse G. TaghianEmail author
Brief Report


Extensive lymph node (LN) involvement portends significant risk for distant metastasis (DM) among breast cancer patients. As a result, local management may be of secondary import to systemic control in this population. We analyzed patients with ≥10 involved LNs (N3) to evaluate the feasibility of breast conserving therapy (BCT) vs modified radical mastectomy (MRM) in this high-risk cohort. Among 98 women with N3 disease 46 (46.9 %) underwent BCT and 52 (53.1 %) received MRM. Nearly all patients (92 %) received comprehensive radiotherapy (RT) including axillary and supraclavicular fields. The Kaplan–Meier method and Cox regression analyses were used to analyze time-to-event outcomes. Median follow-up was 76 months, with a 5-year DFS of 64.9 % and OS of 71.9 % among the cohort. Poorly differentiated (p = 0.007), ER-negative tumors (p = 0.015) had adverse DFS outcomes. Treatment groups did not differ with regard to 10-year DFS (45.4 % for MRM vs. 57.6 % for BCT; p = 0.31), or OS (61.4 vs. 63.7 %; p = 0.79). DM-free survival was 48.9 % following MRM and 60.6 % following BCT (p = 0.19). Patients with ≥10 involved LNs have similar outcomes following BCT or MRM, suggesting that RT may obviate the need for more-extensive surgery. While local control is comparably favorable regardless of surgical approach, systemic control remains a challenge in this population.


Breast cancer Mastectomy Lumpectomy Recurrence Radiotherapy 


Compliance with ethical standards

Conflicts of interest



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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Lior Z. Braunstein
    • 1
  • Sigolene Galland-Girodet
    • 2
  • Saveli Goldberg
    • 2
  • Laura E. G. Warren
    • 1
  • Betro T. Sadek
    • 2
  • Mina N. Shenouda
    • 2
  • Rita F. Abi-Raad
    • 2
  • Shannon M. MacDonald
    • 2
  • Alphonse G. Taghian
    • 2
    Email author
  1. 1.Harvard Radiation Oncology ProgramBostonUSA
  2. 2.Department of Radiation OncologyMassachusetts General HospitalBostonUSA

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