Breast Cancer Research and Treatment

, Volume 152, Issue 3, pp 589–599 | Cite as

Does internal mammary node irradiation affect treatment outcome in clinical stage II–III breast cancer patients receiving neoadjuv ant chemotherapy?

  • Kyung Hwan Kim
  • Jae Myoung Noh
  • Yong Bae Kim
  • Jee Suk Chang
  • Ki Chang Keum
  • Seung Jae Huh
  • Doo Ho Choi
  • Won Park
  • Chang-Ok SuhEmail author
Clinical trial


The purpose of this study is to assess the value of internal mammary node irradiation (IMNI) in patients receiving postoperative radiotherapy after neoadjuvant chemotherapy (NAC) using modern systemic therapy. Between 2001 and 2009, 521 consecutive patients with clinical stage II–III breast cancer received NAC and postoperative radiotherapy. With a consistent policy, the treating radiation oncologist either included (N = 284) or excluded (N = 237) the internal mammary node in the treatment volume. Anthracycline- and taxane-based chemotherapy was provided to 482 (92.5 %) patients. To account for the unbalanced characteristics between the two groups, we performed propensity score matching and covariate adjustment using the propensity score. The median follow-up duration was 71 months (range 31–153 months). The 5-year disease-free survival (DFS) with and without IMNI was 81.8 and 72.7 %, respectively (p = 0.019). The benefit of IMNI varied according to patient characteristics such that it was more apparent in patients with N1–2 disease, inner/central location, and triple-negative subtype. After adjusting for all potential confounding variables, IMNI was independently associated with improved DFS (p = 0.049). The significant effect of IMNI on DFS was sustained after propensity score matching (p = 0.040) and covariate adjustment using the propensity score (p = 0.048). Symptomatic radiation pneumonitis developed in 9 (3.2 %) patients receiving IMNI. Our results indicated that IMNI was associated with a significant improvement in DFS with low toxicity rate for breast cancer patients receiving NAC. Further prospective studies are warranted to confirm the effect of IMNI in the NAC setting.


Internal mammary node irradiation Neoadjuvant chemotherapy Breast cancer 



This work was supported by a Grant from the National R&D Program for Cancer Control, Ministry for Health, Welfare, and Family Affairs, Republic of Korea (0820010).

Compliance with ethical standards

Conflict of interest statement

The authors declare that they have no conflict of interest.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

10549_2015_3505_MOESM1_ESM.tif (378 kb)
Supplemental Fig. 1 Disease-free survival (a) and overall survival (b) of patients receiving internal mammary node irradiation (IMNI) and those who did not (non-IMNI). Hazard ratios (HR), 95 % confidence intervals (CI), and P values were estimated using the clustered marginal Cox model adjusting for matched design.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Kyung Hwan Kim
    • 1
  • Jae Myoung Noh
    • 2
  • Yong Bae Kim
    • 1
  • Jee Suk Chang
    • 1
  • Ki Chang Keum
    • 1
  • Seung Jae Huh
    • 2
  • Doo Ho Choi
    • 2
  • Won Park
    • 2
  • Chang-Ok Suh
    • 1
    Email author
  1. 1.Department of Radiation Oncology, Yonsei Cancer CenterYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Radiation Oncology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea

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