Journal of Rafsanjan University of Medical Sciences

  The Results of Radiotherapy Versus No Radiotherapy of Internal Mammary Chain in Breast Cancer: the Results of 14 Years Therapy

  M.J. Saalabian MD¹, D. Moslemi MD², M.H. Larizadeh MD^3*, A. Mosallaee MD¹, Sh. Omidvary MD⁴, M. Mohammadianpanah MD⁴, N. Ahmadloo MD⁴, J. Ahmadykahnali GP⁵

  1- Associated Professor, Radiotherapy and Oncology, University of Medical Sciences, Shiraz, Iran

  2- Oncologist of Radiotherapy and oncology, University of Medical Sciences, Babol, Iran

  3- Associated Professor of Radiotherapy and Oncology, University of Medical Sciences, Kerman, Iran

  4- Assistant Professor of Radiotherapy and Oncology, University of Medical Sciences, Shiraz, Iran

  5- General Physician, University of Medical Sciences, Rafsanjan, Iran

  Background : The selective treatment of internal mammary chain (IMC) in breast cancer is controversial. Previous randomized trials have not shown a benefit to IMC irradiation. The recent positive trials testing postmastectomy radiation that had included IMC irradiation has renewed interest in their irradiation. The purpose of this retrospective survey was to evaluate outcome as a function of IMC in a cohort of breast cancer patients treated with modified radical mastectomy (MRM) and radiation therapy (RT).

  Materials and Methods: From 1987 to 2001, the files of 215 patients with invasive breast cancer that were treated with MRM+RT were reviewd. The mean time of follow up was 74 months. All of the patients received chemotherapy and regional radiation (supraclavicular, axillary with or without IMC). The decision to use or not use a separate IMC field was the result of change in treatment policy over time. To evaluate the results, patients were divided into two groups: those who received IMC radiation (IMC group, 120 patients), and those without IMC radiation therapy (control group, 95 patients). Five years disease free survival rate, metastasis and locoregional recurrence was caculated in two groups. To determine the patients who can benefit from radiotherapy the metastasis in two groups was analysed according to age, the location of tumor, the stage of disease and the situation of axillary lynph nodes.

  Results: Distant metastasis and locoregional recurrence occurred in 42(35%) and 10(8.3%) patients in IMC group and 37 (38.94%) and 7 (7.3%) patients in control group, respectively. These differences were not significant between 2 groups. Subset analysis showed that distant metastasis occurred less frequently in IMC group when the location of tumor was inner quadrant (42.85% vs 75%) and stage Шa was (38.2% vs 84.6%) (p<0.001). Five years disease free survival rate was 57% and 50% in IMC and control group respectively.

  Conclusion: Regardes to the results of this retrospective analysis, it could be concluded that IMC radiation in breast cancer patients is not beneficial. This treatment should be considered only for those with inner quadrants and stage Шa tumors.

  Key words: Breast cancer, Internal mammary chain, Radiotherapy�

  *Corresponding author:Tel: (0341) 2115810, Fax:(0341)2115803 E-mail: Larizadeh_mh@yahoo.com

  Journal of Rafsanjan University of Medical Sciences and Health Services, 2005, 4(1):1-8