Abstract 1082: Treatment of Internal Mammary Nodes Associated with

Improved Overall Survival in Breast Cancer: A Meta-Analysis

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 Disclosure
• Parvez M. Shaikh, MD
• Department of Radiation Oncology, West Virginia University School of Medicine,
Morgantown, WV
• Disclosure: Author has no conflicts of interest to disclose.

• Mohammad T. Khasawneh, PhD

• Department of Systems Science and Industrial Engineering at Binghamton University,
Binghamton, NY
• Disclosure: Author has no conflicts of interest to disclose.

• John A. Vargo, MD
• Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh
School of Medicine, Pittsburgh, PA
• Disclosure: Author receives honoraria from Elsevier for Clinical Pathways

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 Objective

• The role of internal mammary nodal irradiation (IMNI) as a component of regional

nodal radiotherapy is a controversial issue in breast radiation oncology with
conflicting results presented in recent landmark trials.

• We thus created a meta-analysis of available data to better ascertain the potential

benefit of IMNI.

• We hypothesize that with the increased power available within a meta-analysis,

IMNI will prove to improve overall survival in breast cancer.

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 Methods
• Four studies with a total of 5,258 patients (IMNI = 2698, No IMNI = 2560) were
identified based on PubMed and EMBASE searches.

• Primary end point: Overall survival (OS).

• Secondary endpoints:
• Disease free survival (DFS)
• Breast cancer mortality (BCM)
• Distant metastasis free survival (DMFS).

• Subgroup analyses were performed

• Medial/central tumor location
• pN+ versus pN0 status.

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 Results
• Pooled results showed IMNI significantly
improved OS for all comers (HR 0.88, 95%
CI 0.80-0.98, p=0.02)

• OS was improved for subgroups:

• pN+ with medial/central tumor location (HR 0.80,
95% CI 0.68-0.94, p=0.005)
• pN+ with lateral tumor location (HR 0.86, 95% CI
0.745-0.995, p=0.04).

• There was no significant difference in OS

for subgroups of pN0 and medial/central
tumor location.

• Secondary endpoints improved with IMNI:

• DFS (HR 0.90, 95% CI 0.82-0.99, p=0.03)
• BCM (HR 0.83, 95% CI 0.73-0.96, p=0.01)
• DMFS (HR 0.88, 95% CI 0.78-0.99, p=0.04

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 Conclusion

• Inclusion of IMNI to regional nodes improves OS in breast cancer

• Strongest effect noted in pN+ patients with medial/central tumor

location.

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