Detection, treatment, and outcome of isolated supraclavicular recurrence in 42 patients with invasive breast carcinoma

Background: There still is debate as to whether breast carcinoma patients with isolated supraclavicular recurrence should be considered to be patients with disseminated disease or patients for whom aggressive treatment with curative intent is justified.

Methods: In the period 1984-1994, 4669 patients with invasive breast carcinoma underwent axillary dissection in 1 of 8 community hospitals in the southeastern part of the Netherlands. During follow-up, 42 patients with isolated supraclavicular recurrence, without other sites of distant disease, were identified.

Results: The median interval between treatment of the primary tumor and diagnosis of the supraclavicular recurrence was 2.5 years (range, 0.2-11.5 years). Radiotherapy was administered to 25 patients (60%), 5 of whom also underwent surgery and 16 of whom also received chemotherapy or hormonal therapy. Eleven patients received hormonal therapy only, and four received chemotherapy only. One patient received surgical treatment only, and one patient remained untreated. Complete remission was achieved in 35 patients (83%), but a second supraclavicular recurrence occurred in 12 (34% of patients who achieved complete remission). Overall, 6 patients (14%) were alive without evidence of disease after a follow-up period of 4.4-8.3 years. The 5-year actuarial overall survival and distant disease-free survival rates, based on the date of diagnosis of supraclavicular recurrence, were 38% (95% confidence interval [CI], 23-53%) and 22% (95% CI, 8-35%), respectively. The distant disease-free survival rate was somewhat better for the 25 patients who underwent radiotherapy as part of the treatment for supraclavicular recurrence than it was for the 17 patients who did not receive radiotherapy (P = 0.06); the difference became more pronounced after the exclusion of 8 patients who had received axillary and supraclavicular radiotherapy as part of treatment for the primary tumor (P = 0.002).

Conclusions: Although complete remission can be obtained in most patients with isolated supraclavicular recurrence, the prognosis for these patients is poor. Involved field radiotherapy appears to play an important role in the treatment of supraclavicular recurrence and may improve the distant recurrence-free survival rate.