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Int. J. Radiat. Oncol. Biol. Phys. · Jul 2012
Factors associated with the development of breast cancer-related lymphedema after whole-breast irradiation.
- Chirag Shah, John Ben Wilkinson, Andrew Baschnagel, Mihai Ghilezan, Justin Riutta, Nayana Dekhne, Savitha Balaraman, Christina Mitchell, Michelle Wallace, and Frank Vicini.
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
- Int. J. Radiat. Oncol. Biol. Phys. 2012 Jul 15;83(4):1095-100.
PurposeTo determine the rates of breast cancer-related lymphedema (BCRL) in patients undergoing whole-breast irradiation as part of breast-conserving therapy (BCT) and to identify clinical, pathologic, and treatment factors associated with its development.Methods And MaterialsA total of 1,861 patients with breast cancer were treated at William Beaumont Hospital with whole-breast irradiation as part of their BCT from January 1980 to February 2006, with 1,497 patients available for analysis. Determination of BCRL was based on clinical assessment. Differences in clinical, pathologic, and treatment characteristics between patients with BCRL and those without BCRL were evaluated, and the actuarial rates of BCRL by regional irradiation technique were determined.ResultsThe actuarial rate of any BCRL was 7.4% for the entire cohort and 9.9%, 14.7%, and 8.3% for patients receiving a supraclavicular field, posterior axillary boost, and internal mammary irradiation, respectively. BCRL was more likely to develop in patients with advanced nodal status (11.4% vs. 6.3%, p = 0.001), those who had a greater number of lymph nodes removed (14 nodes) (9.5% vs. 6.0%, p = 0.01), those who had extracapsular extension (13.4% vs. 6.9%, p = 0.009), those with Grade II/III disease (10.8% vs. 2.9%, p < 0.001), and those who received adjuvant chemotherapy (10.5% vs. 6.7%, p = 0.02). Regional irradiation showed small increases in the rates of BCRL (p = not significant).ConclusionsThese results suggest that clinically detectable BCRL will develop after traditional BCT in up to 10% of patients. High-risk subgroups include patients with advanced nodal status, those with more nodes removed, and those who receive chemotherapy, with patients receiving regional irradiation showing a trend toward increased rates.Copyright © 2012 Elsevier Inc. All rights reserved.
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