Role of Axillary Radiotherapy in Patients of Locally Advanced Carcinoma Breast with Inadequate or unknown Lymph Node Dissection Status - An Institutional Audit

ABSTRACT

Introduction: Loco-regional radiotherapy to supraclavicularand Axillary region has been the standard of care for treatmentof locally advanced carcinoma breast without or doubtfulaxillary clearance. We did a clinical audit of the patient careprovided and the outcome of the same relating to loco-regionalradiotherapy for such patients at a district medical college inIndia.Material and methods: All patients with locally advancedcarcinoma breast between 2007 and 2013 who had treatmentin the Department of Radiotherapy were audited. The patientswere stratified as per surgery they had and pathologicalinformation that was available in their post op HPE reportalong with type of radiotherapy they received. The analysiswas done with IBM SPSS V23.Results: over the period of 6 years there were 874 patientsof carcinoma breast registered in the Department. Out ofthem 246 were metastatic. 12 were early breast carcinomas,rest 616 were LABC who had indications of Supraclavicularand Axillary RT due to any reason. Out of these 616 patientsthe indication in 592 patients was lack of pathologicalinformation in terms of number of nodes dissected beinglesser than 10. 138 of them were referred from other centerswhere Radiotherapy was not available and therefore theyfollowed up at other centers. 77 patients never completed theirtreatment (radiotherapy or chemotherapy). Additionally 42patients never came for any follow up after their treatmentcompletion. A total of 359 analyzable patient records werefound who had at least one follow up.Conclusion: In our audit due to limited resources nearly 63%of the patients received RT only chest wall and supraclavicularregion RT. However it did not change the loco-regionalfailure rate at 5.3 years. A longer follow up data of 10 yearsis necessary to see whether this trend is continued to OS.However the present retrospective data provides a startingpoint for prospective clinical trials to look if certain groupof patients may benefit from omitting Axillary Radiotherapyeven when the dissection had yielded lesser than 10 nodes