EVALUATION OF INTERNAL MAMMARY LYMPH NODES DISSECTION COMBINED WITH SELECTIVE POSTOPERATIVE RADIOTHERAPY IN PATIENTS WITH MEDIAL BREAST CANCERS

• Published in: Japanese Journal of National Medical Services Vol. 52; no. 8; pp. 497 - 503
• Main Authors: KANNO, Keiichi, ROPPONGI, Takashi, MITOMO, Osamu, FUJII, Takanao, SAKAMOTO, Ichiro, YOKOTA, Toru
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of National Medical Services 1998; 一般社団法人 国立医療学会
• Subjects: extended radical mastectomy; internal mammary lymph node metastasis; medial breast cancer; postoperative radiotherapy; 乳癌の術後放射線療法; 内側乳癌; 拡大乳房切除術; 胸骨傍リンパ節転移; 胸骨傍郭清
• ISSN: 0021-1699; 1884-8729
• DOI: 10.11261/iryo1946.52.497

In the reason that internal mammary lymph nodes (IMN) dissection of extended radical mastectomy (EXT) did not influence overall survival rates in patients with medial or central breast cancers, this procedure is seldom practiced in the European countries and the United States. But in the thought that IMN dissection combined with selective postoperative radiotherapy might increase disease-free or overall survival in these patients, this combined therapy in patients with medial breast cancers was evaluated. 35 patients submitted to IMN dissection with extrapleural method and 114 patients submitted to non-dissection were evaluated in this study. Postoperative prophylactic radiotherapy (to IMN and supraclavicular lymph nodes) was administered to patients with histologically positive IMN or more than 4 of axillary lymph nodes. The dose of irradiation was 5000 to 5100 cGy given in 5 to 6 weeks. Patient characteristics in the two groups did not reveal any significant difference statistically. Statistical analysis was carried out both on disease-free survival and overall survival, computed from the date of radical surgery, by use of the Kaplan-Meier method. Both groups of survival were compared, using the Logrank test. The frequency of IMN metastasis is significantly associated with the one of axillary lymph nodes metastasis (p=0.03). The analysis of the percent disease-free survival related to the presence or absence of IMN dissection failed to reveal any significant difference (10 years disease-free survival rate 56.1% and 74.5%, respectively). In the same way, the analysis of the percent overall survival failed to reveal any significant difference (10 years overall survival rate 58.8% and 80.4%, respectively).