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Risk of lymphedema after regional nodal irradiation with breast conservation therapy
- Source :
- International journal of radiation oncology, biology, physics. 55(5)
- Publication Year :
- 2003
-
Abstract
- Purpose To evaluate the risk factors for lymphedema in patients receiving breast conservation therapy for early-stage breast cancer. Methods and materials Between 1982 and 1995, 727 Stage I–II breast cancer patients were treated with breast conservation therapy at Massachusetts General Hospital. A retrospective analysis of the development of persistent arm edema was performed. Lymphedema was defined as a >2-cm difference in forearm circumference compared with the untreated side. The median follow-up was 72 months. Breast and regional nodal irradiation (BRNI) was administered in 32% of the cases and breast irradiation alone in 68%. Results Persistent arm lymphedema was documented in 21 patients. The 10-year actuarial incidence was 4.1%. The median time to edema was 39 months. The only significant risk factor for lymphedema was BRNI. The 10-year risk was 1.8% for breast irradiation alone vs. 8.9% for BRNI ( p = 0.001). The extent of axillary dissection did not predict for lymphedema even within the subgroups of patients defined by the extent of irradiation. Most patients underwent Level I or II dissection. In this subgroup, the lymphedema risk at 10 years was 10.7% for BRNI vs. 1.0% for breast irradiation alone ( p = 0.0003). Conclusion Nodal irradiation was the only significant risk factor for arm lymphedema in patients receiving breast conservation therapy for early-stage breast cancer. Our data suggest that this risk is low with Level I/II dissection and breast irradiation. However, even after the addition of radiotherapy to the axilla and supraclavicular fossa, the development of lymphedema was only 1 in 10, lower than generally recognized.
- Subjects :
- Cancer Research
medicine.medical_specialty
medicine.medical_treatment
Breast Neoplasms
Mastectomy, Segmental
Neoplasms, Multiple Primary
Radiotherapy, High-Energy
Breast cancer
Risk Factors
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Radiology, Nuclear Medicine and imaging
Life Tables
Lymphedema
Risk factor
skin and connective tissue diseases
Cyclophosphamide
Neoadjuvant therapy
Retrospective Studies
Radiation
Lymphatic Irradiation
business.industry
Retrospective cohort study
medicine.disease
Combined Modality Therapy
humanities
Neoadjuvant Therapy
Surgery
body regions
Radiation therapy
Axilla
Tamoxifen
medicine.anatomical_structure
Treatment Outcome
Oncology
Chemotherapy, Adjuvant
Doxorubicin
Lymph Node Excision
Female
Radiotherapy, Adjuvant
Dose Fractionation, Radiation
Fluorouracil
business
Mastectomy
Boston
Subjects
Details
- ISSN :
- 03603016
- Volume :
- 55
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- International journal of radiation oncology, biology, physics
- Accession number :
- edsair.doi.dedup.....43bd169cc0864daa31f110c8e0075da1