PURPOSE: The development of breast cancer-related lymphedema (LE) is closely related to the number of dissected axillary lymph nodes (N-ALNs), chemotherapy, and radiation therapy. In this study, we attempted to estimate the risk of LE based on combinations of these treatment-related factors. METHODS AND MATERIALS: A total of 772 patients with breast cancer, who underwent primary surgery with axillary lymph node dissection from 2004 to 2009, were retrospectively analyzed. Adjuvant chemotherapy (ACT) was performed in 677 patients (88%). Among patients who received radiation therapy (n=675), 274 (35%) received supraclavicular radiation therapy (SCRT). RESULTS: At a median follow-up of 5.1 years (range, 3.0-8.3 years), 127 patients had developed LE. The overall 5-year cumulative incidence of LE was 17%. Among the 127 affected patients, LE occurred within 2 years after surgery in 97 (76%) and within 3 years in 115 (91%) patients. Multivariate analysis showed that N-ALN (hazard ratio [HR], 2.81; P<.001), ACT (HR, 4.14; P=.048), and SCRT (HR, 3.24; P<.001) were independent risk factors for LE. The total number of risk factors correlated well with the incidence of LE. Patients with no risk or 1 risk factor showed a significantly lower 5-year probability of LE (3%) than patients with 2 (19%) or 3 risk factors (38%) (P<.001). CONCLUSIONS: The risk factors associated with LE were N-ALN, ACT, and SCRT. A simple model using combinations of these factors may help clinicians predict the risk of LE.
PURPOSE: The development of breast cancer-related lymphedema (LE) is closely related to the number of dissected axillary lymph nodes (N-ALNs), chemotherapy, and radiation therapy. In this study, we attempted to estimate the risk of LE based on combinations of these treatment-related factors. METHODS AND MATERIALS: A total of 772 patients with breast cancer, who underwent primary surgery with axillary lymph node dissection from 2004 to 2009, were retrospectively analyzed. Adjuvant chemotherapy (ACT) was performed in 677 patients (88%). Among patients who received radiation therapy (n=675), 274 (35%) received supraclavicular radiation therapy (SCRT). RESULTS: At a median follow-up of 5.1 years (range, 3.0-8.3 years), 127 patients had developed LE. The overall 5-year cumulative incidence of LE was 17%. Among the 127 affected patients, LE occurred within 2 years after surgery in 97 (76%) and within 3 years in 115 (91%) patients. Multivariate analysis showed that N-ALN (hazard ratio [HR], 2.81; P<.001), ACT (HR, 4.14; P=.048), and SCRT (HR, 3.24; P<.001) were independent risk factors for LE. The total number of risk factors correlated well with the incidence of LE. Patients with no risk or 1 risk factor showed a significantly lower 5-year probability of LE (3%) than patients with 2 (19%) or 3 risk factors (38%) (P<.001). CONCLUSIONS: The risk factors associated with LE were N-ALN, ACT, and SCRT. A simple model using combinations of these factors may help clinicians predict the risk of LE.
Authors: Susan G R McDuff; Amir I Mina; Cheryl L Brunelle; Laura Salama; Laura E G Warren; Mohamed Abouegylah; Meyha Swaroop; Melissa N Skolny; Maria Asdourian; Tessa Gillespie; Kayla Daniell; Hoda E Sayegh; George E Naoum; Hui Zheng; Alphonse G Taghian Journal: Int J Radiat Oncol Biol Phys Date: 2018-08-28 Impact factor: 7.038
Authors: Jane M Armer; Karla V Ballman; Linda McCall; Pamela L Ostby; Eris Zagar; Henry M Kuerer; Kelly K Hunt; Judy C Boughey Journal: JAMA Surg Date: 2019-09-01 Impact factor: 14.766
Authors: Meyha N Swaroop; Chantal M Ferguson; Nora K Horick; Melissa N Skolny; Cynthia L Miller; Lauren S Jammallo; Cheryl L Brunelle; Jean A O'Toole; Steven J Isakoff; Michelle C Specht; Alphonse G Taghian Journal: Breast Cancer Res Treat Date: 2015-05-05 Impact factor: 4.872