Warren LE, Miller CL, Horick N, Skolny MN, Jammallo LS, Sadek BT, Shenouda MN, O'Toole JA, MacDonald SM, Specht MC, Taghian AG, et al.
International journal of radiation oncology, biology, physics. Date of publication 2014 Mar 1;volume 88(3):565-71.
1. Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):565-71. doi:
10.1016/j.ijrobp.2013.11.232. Epub 2014 Jan 7.
The impact of radiation therapy on the risk of lymphedema after treatment for
breast cancer: a prospective cohort study.
Warren LE(1), Miller CL(1), Horick N(2), Skolny MN(1), Jammallo LS(1), Sadek
BT(1), Shenouda MN(1), O'Toole JA(3), MacDonald SM(1), Specht MC(4), Taghian
AG(5).
Author information:
(1)Department of Radiation Oncology, Massachusetts General Hospital, Boston,
Massachusetts.
(2)Department of Biostatistics, Massachusetts General Hospital, Boston,
Massachusetts.
(3)Department of Physical and Occupational Therapy, Massachusetts General
Hospital, Boston, Massachusetts.
(4)Division of Surgical Oncology, Massachusetts General Hospital, Boston,
Massachusetts.
(5)Department of Radiation Oncology, Massachusetts General Hospital, Boston,
Massachusetts. Electronic address: ataghian@partners.org.
Comment in
Nat Rev Clin Oncol. 2014 Mar;11(3):121.
PURPOSE/OBJECTIVE: Lymphedema after breast cancer treatment can be an
irreversible condition with a negative impact on quality of life. The goal of
this study was to identify radiation therapy-related risk factors for lymphedema.
METHODS AND MATERIALS: From 2005 to 2012, we prospectively performed arm volume
measurements on 1476 breast cancer patients at our institution using a Perometer.
Treating each breast individually, 1099 of 1501 patients (73%) received radiation
therapy. Arm measurements were performed preoperatively and postoperatively.
Lymphedema was defined as ≥10% arm volume increase occurring >3 months
postoperatively. Univariate and multivariate Cox proportional hazard models were
used to evaluate risk factors for lymphedema.
RESULTS: At a median follow-up time of 25.4 months (range, 3.4-82.6 months), the
2-year cumulative incidence of lymphedema was 6.8%. Cumulative incidence by
radiation therapy type was as follows: 3.0% no radiation therapy, 3.1% breast or
chest wall alone, 21.9% supraclavicular (SC), and 21.1% SC and posterior axillary
boost (PAB). On multivariate analysis, the hazard ratio for regional lymph node
radiation (RLNR) (SC ± PAB) was 1.7 (P=.025) compared with breast/chest wall
radiation alone. There was no difference in lymphedema risk between SC and SC +
PAB (P=.96). Other independent risk factors included early postoperative swelling
(P<.0001), higher body mass index (P<.0001), greater number of lymph nodes
dissected (P=.018), and axillary lymph node dissection (P=.0001).
CONCLUSIONS: In a large cohort of breast cancer patients prospectively screened
for lymphedema, RLNR significantly increased the risk of lymphedema compared with
breast/chest wall radiation alone. When considering use of RLNR, clinicians
should weigh the potential benefit of RLNR for control of disease against the
increased risk of lymphedema.
Copyright © 2014 Elsevier Inc. All rights reserved.
DOI: 10.1016/j.ijrobp.2013.11.232
PMCID: PMC3928974
PMID: 24411624 [Indexed for MEDLINE]
