• Radiother Oncol · Feb 2019

    Impact of modern-day axillary treatment on patient reported arm morbidity and physical functioning in breast cancer patients.

    • Madelijn L Gregorowitsch, Helena M Verkooijen, Anette Houweling, Nick Fuhler, Ron Koelemij, Ernst J P Schoenmaeckers, Maartje F Sier, Miranda F Ernst, Arjen J Witkamp, Thijs Van Dalen, Danny A Young-Afat, Desiree H J G van den Bongard, and UMBRELLA study group.
    • Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands. Electronic address: m.l.gregorowitsch@umcutrecht.nl.
    • Radiother Oncol. 2019 Feb 1; 131: 221-228.

    PurposeTo reduce arm morbidity, routine axillary lymph node dissection (ALND) is often omitted or replaced by axillary radiotherapy (AxRT) in patients with limited nodal involvement. We evaluated patient-reported arm morbidity and physical functioning in breast cancer patients undergoing modern-day axillary treatment.MethodsAll patients within the UMBRELLA cohort undergoing local radiotherapy with sentinel lymph node biopsy (SLNB), ALND and/or AxRT were selected. Patient-reported arm morbidity and physical functioning were assessed with EORTC QLQ C30/BR23 questionnaires up to eighteen months after initiation of radiotherapy. Patient-reported outcomes were compared between patients with SLNB only, ALND only, AxRT (level I-II), AxRT (level I-IV) or AxRT plus ALND by means of mixed model analysis.ResultsIn total, 949 patients were identified; 641 (68%) SLNB only, 57 (6%) ALND only, 94 (10%) AxRT level I-II, 72 (8%) AxRT level I-IV and 85 (9%) ALND + AxRT. SLNB only resulted in the least arm morbidity scores. ALND + AxRT resulted in most arm morbidity, with clinically relevant differences at 18 months. AxRT (level I-II or level I-IV) resulted in significantly less arm symptoms in the first 3 months compared to ALND. Arm symptom scores between those receiving AxRT on levels I-II and I-IV were similar.ConclusionOf all axillary management strategies, ALND plus AxRT is associated with worst patient-reported outcomes. AxRT resulted in less arm morbidity compared to ALND. Selective radiotherapy treatment of the axilla, i.e. radiotherapy of levels I-II only instead of levels I-IV, did not lead to clinically relevant reduced arm morbidity.Copyright © 2018 Elsevier B.V. All rights reserved.

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