Frequency and risk factors for arm lymphedema after multimodal breast-conserving treatment of nodal positive breast Cancer - a long-term observation

Radiat Oncol. 2019 Mar 7;14(1):39. doi: 10.1186/s13014-019-1243-y.

Abstract

Background: Arm-lymphedema is a major complication after breast cancer. Recent studies demonstrate the validity of predicting Breast Cancer Related Lymphedema (BCRL) by self-reports. We aimed to investigate the rate of BCRL and its risk factors in the long-term using self-reported symptoms.

Methods: Data was collected from 385 patients who underwent multimodal therapy for nodal positive breast cancer, including breast conserving surgery, axillary dissection, and local or locoregional radiotherapy. Two validated questionnaires were used for the survey of BCRL (i.e. LBCQ-D and SDBC-D). These were analysed collectively with retrospective data of our medical records.

Results: 23.5% (n = 43) suffered a permanent BCRL (stage II-III) after a median follow-up time of 10.1 years (4.9-15.9 years); further 11.5% (n = 23) reported at least one episode of reversible BCRL (Stage 0-I) during the follow-up time. 87.1% of the patients with lymphedema developed this condition in the first two years. Adjuvant chemotherapy was a significant risk factor for the appearance of BCRL (p = 0.001; 95%-CI 7.7-10.2).

Conclusions: Breast cancer survivors face a high risk of BCRL, particularly if axillary dissection was carried out. Almost 90% of BCRL occurred during the first two years after radiotherapy. Self-report of symptoms seems to be a suitable instrument of early detection of BCRL.

Keywords: Axillary surgery; BCRL; Breast cancer; Breast-conserving surgery; Lymphedema; Quality of life; Radiotherapy.

MeSH terms

  • Adult
  • Aged
  • Arm
  • Breast Neoplasms / radiotherapy*
  • Breast Neoplasms / surgery*
  • Cancer Survivors
  • Female
  • Humans
  • Incidence
  • Lymph Node Excision / adverse effects
  • Lymphedema / epidemiology
  • Lymphedema / etiology*
  • Mastectomy, Segmental / adverse effects*
  • Middle Aged
  • Radiotherapy, Adjuvant / adverse effects
  • Retrospective Studies
  • Risk Factors
  • Surveys and Questionnaires