PURPOSE: To explore the relationship between radiotherapy (RT) dose levels in the arm/shoulder region and arm/shoulder morbidity in breast cancer patients. MATERIAL AND METHODS: This study included 183 breast cancer patients who had received locoregional RT with or without chemotherapy and/or hormone treatment during the period 1998-2002. Individual RT dose level, reflected by dose-volume histograms (DVHs), for the shoulder joint and joining structures were obtained from archived CT-based RT plans. Individual median, mean and maximum arm/shoulder RT dose levels were extracted. Arm/shoulder morbidity was assessed 29-58 months after breast cancer treatment using the following clinical endpoints: arm pain, arm stiffness, swollen arm, use of arm, numbness, shoulder flexion and shoulder abduction difference, fibrosis and breast cancer-related lymphedema. The relationship between arm/shoulder RT dose level and these clinical endpoints was assessed by Spearman's correlation and multivariate logistic regression. RESULTS: Ninety-one percent of the included patients had some degree of arm/shoulder morbidity. Neither mean nor maximum RT dose level was associated with clinical endpoints. However, significant correlations (p < 0.05) were found between DVHs and arm stiffness, arm pain, use of arm and shoulder abduction difference, when arm/shoulder RT dose levels were approximately 15 Gy. CONCLUSIONS: Three-dimensional conformal locoregional RT for breast cancer results in long-term arm/shoulder morbidity. To minimize this risk, large shoulder volumes receiving RT doses of approximately 15 Gy should be reduced.
PURPOSE: To explore the relationship between radiotherapy (RT) dose levels in the arm/shoulder region and arm/shoulder morbidity in breast cancerpatients. MATERIAL AND METHODS: This study included 183 breast cancerpatients who had received locoregional RT with or without chemotherapy and/or hormone treatment during the period 1998-2002. Individual RT dose level, reflected by dose-volume histograms (DVHs), for the shoulder joint and joining structures were obtained from archived CT-based RT plans. Individual median, mean and maximum arm/shoulder RT dose levels were extracted. Arm/shoulder morbidity was assessed 29-58 months after breast cancer treatment using the following clinical endpoints: arm pain, arm stiffness, swollen arm, use of arm, numbness, shoulder flexion and shoulder abduction difference, fibrosis and breast cancer-related lymphedema. The relationship between arm/shoulder RT dose level and these clinical endpoints was assessed by Spearman's correlation and multivariate logistic regression. RESULTS: Ninety-one percent of the included patients had some degree of arm/shoulder morbidity. Neither mean nor maximum RT dose level was associated with clinical endpoints. However, significant correlations (p < 0.05) were found between DVHs and arm stiffness, arm pain, use of arm and shoulder abduction difference, when arm/shoulder RT dose levels were approximately 15 Gy. CONCLUSIONS: Three-dimensional conformal locoregional RT for breast cancer results in long-term arm/shoulder morbidity. To minimize this risk, large shoulder volumes receiving RT doses of approximately 15 Gy should be reduced.
Authors: Li Wang; Gordon H Guyatt; Sean A Kennedy; Beatriz Romerosa; Henry Y Kwon; Alka Kaushal; Yaping Chang; Samantha Craigie; Carlos P B de Almeida; Rachel J Couban; Shawn R Parascandalo; Zain Izhar; Susan Reid; James S Khan; Michael McGillion; Jason W Busse Journal: CMAJ Date: 2016-07-11 Impact factor: 8.262
Authors: Daniela Mirandola; Guido Miccinesi; Maria Grazia Muraca; Stefania Belardi; Roberta Giuggioli; Eleonora Sgambati; Mirko Manetti; Marco Monaci; Mirca Marini Journal: Support Care Cancer Date: 2017-10-17 Impact factor: 3.603
Authors: Seoyon Yang; Dae Hwan Park; Sei Hyun Ahn; Jisun Kim; Jong Won Lee; Jun Young Han; Dong Kyu Kim; Jae Yong Jeon; Kyoung Hyo Choi; Won Kim Journal: Support Care Cancer Date: 2016-12-09 Impact factor: 3.603