Kadri Altundag
MKA Breast Cancer Clinic, Tepe Prime, Ankara, Turkey.
Abstract
Dear Editor,
Isolated breast cancer metastasis to contralateral supraclavicular lymph node (CSM) without metastases to any other distant organ is currently assigned M1 status (stage IV) instead of N3 (stage III). Lymph node metastases in the contralateral axilla is consindered to be a locoregional spread of the tumor from the index breast via lymphatics rather than hematogenous spread [1]. Isolated CSM in breast cancer patients should not be classified as stage IV disease. Likewise, contralateral axillary nodal metastases (CAM) are classified as stage IV disease, although many centers treat CAM with curative intent. One study showed that CAM patients who received multi-modal therapy with curative intent may have overall survival (OS) more comparable to locally advanced breast cancer patients (LABC) than metastatic patients [2]. A 48-year-old woman was diagnosed with LABC right invasive ductal breast cancer carcinoma (cT3N2M0) with luminal B subtype in May 2015 and received neo-adjuvant chemotherapy of four cyles of adriamycin-cyclophosphamide followed by 12 weeks of paclitaxel and then she underwent right modified radical mastectomy with stage pT1N2M0 disease and luminal subtype B in December 2015 and then she started to receive adjuvant radiotherapy and adjuvant tamoxifen and ovarian function suppression. On routine follow-up, left supraclavivular lymphadenopathy was detected in breast ultrasonography in November 2021 and fine needle aspiration from lymphadenopathy showed atypical suspicious malignant cells while PET-CT scan showed only metastatic supraclavicular lymphadenopathy and 5 CSMs were excised with 5 nodal metastases-one with extracapsular extension with luminal B subtype in December 2021 and letrozole plus ribociclip were initiated and radiotherapy to left SCMs was planned as well. Furthermore, next generation and PD-L1 determination were ordered. Oligometastatic breast cancer, typically defined as the presence of 1-5 metastases, represents an intermediate state between locally advanced and widely metastatic disease. Emerging research suggests that oligometastatic cancer has a unique molecular signature distinct from widely metastatic disease, and that it carries a better prognosis. Owing to its more limited capacity for widespread progression, oligometastatic disease may benefit from aggressive ablative therapy to known metastases. Options for ablation include surgical excision, radiofrequency ablation, and hypofractionated image-guided radiotherapy (HIGRT) [3,4]. Therefore, for this specific patient, we try to initiate aggressive local treatment concurrent with systemic treatment.
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