A Model to Estimate the Risk of Breast Cancer-Related Lymphedema: Combinations of Treatment-Related Factors of the Number of Dissected Axillary Nodes, Adjuvant Chemotherapy, and Radiation Therapy

Kim, Myung-Soo; Kim, Seok Won; Lee, Sung Uk; Lee, Nam Kwon; Jung, So‐Youn; Kim, Tae Hyun; Kang, Hyejin; Shin, Kyung Hwan

doi:10.1016/j.ijrobp.2013.02.018

Cited by 90 publications

(77 citation statements)

References 17 publications

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“…We have since expanded on this finding, showing a clear association between chemotherapy and an increased risk of LE in the context of both ACT and NCT [3,9], with taxane identified as an independent risk factor for LE [8]. In the current study, chemotherapy with taxane, compared with no chemotherapy or chemotherapy without taxane, increased the risk of TLE and PLE.…”

Section: Discussionmentioning

confidence: 62%

“…The treatment-related factors N-ALN, SCRT, and taxane chemotherapy have been shown to significantly affect the development of LE [3,8,9]; therefore we examined whether the tendency of TLE and PLE could be estimated using those factors. The incidences of TLE and PLE relative to the number of treatment factors in 351 patients with initial grade 1 swelling are shown in Table 4.…”

Section: Resultsmentioning

confidence: 99%

“…Determination of LE was based on both objective (circumference measurement) and subjective (patient perception of arm edema) assessments, as described previously [3]. Beginning in 2004, measurement and assessment of LE was performed in all patients by a single physician (K.H.S.)…”

Section: Methodsmentioning

confidence: 99%

“…It is characterized by an accumulation of protein-rich fluids caused by an interruption in the axillary lymphatic drainage from the arm [2]. Due to the increased survival of breast cancer patients, LE has emerged as an important long-term morbidity, resulting in functional, cosmetic, and psychological problems, all of which may significantly impact quality of life [3]. …”

Section: Introductionmentioning

confidence: 99%

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Identification of Prognostic Risk Factors for Transient and Persistent Lymphedema after Multimodal Treatment for Breast Cancer

et al. 2016

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PurposeThe purpose of this study is to identify risk factors for transient lymphedema (TLE) and persistent lymphedema (PLE) following treatment for breast cancer.Materials and MethodsA total of 1,073 patients who underwent curative breast surgery were analyzed. TLE was defined as one episode of arm swelling that had resolved spontaneously by the next follow-up; arm swelling that persisted over two consecutive examinations was considered PLE.ResultsAt a median follow-up period of 5.1 years, 370 cases of lymphedema were reported, including 120 TLE (11.2%) and 250 PLE (23.3%). Initial grade 1 swelling was observed in 351 patients, of which 120 were limited to TLE (34%), while the other 231 progressed to PLE (66%). All initial swelling observed in TLE patients was classified as grade 1. In multivariate analysis, chemotherapy with taxane and supraclavicular radiation therapy (SCRT) were associated with development of TLE, whereas SCRT, stage III cancer and chemotherapy with taxane were identified as risk factors for PLE (p < 0.05). The estimated incidence of TLE among initial grade 1 patients was calculated using up to three treatment-related risk factors (number of dissected axillary lymph nodes, SCRT, and taxane chemotherapy). The approximate ratios of TLE and PLE based on the number of risk factors were 7:1 (no factor), 1:1 (one factor), 1:2 (two factors), and 1:3 (three factors).ConclusionOne-third of initial swelling events were transient, whereas the other two-thirds of patients experienced PLE. Estimation of TLE and PLE based on known treatment factors could facilitate prediction of this life-long complication.

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Section: Discussionmentioning

confidence: 62%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Identification of Prognostic Risk Factors for Transient and Persistent Lymphedema after Multimodal Treatment for Breast Cancer

et al. 2016

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“…These categorical variables included age group (<50 years, 50–65 years, or >65 years), BMI group (<27 kg/m 2 or ≥27 kg/m 2 ), menstrual status (reached menopause or not), TNM stage (Stages 0–2 or 3), histologic grade (Grade 1, 2, or 3), axillary lymph node invasion (negative or positive), tumor size (<2 cm, 2–5 cm, or >5 cm), surgery type (BCS, simple mastectomy, or MRM), number of dissected axillary lymph nodes (dichotomized as ≤20 or >20), and receiving adjuvant radiation therapy or chemotherapy (no or yes). Univariate and multivariate Cox proportional hazards regression models were used to evaluate the relative prognostic significance of the variables in predicting the occurrence of upper-limb lymphedema 22. Based on 1-year steps, the entry time was the date of breast cancer surgery and the exit time was the occurrence of postsurgical upper-limb lymphedema during the follow-up.…”

Section: Methodsmentioning

confidence: 99%

Role of physiotherapy and patient education in lymphedema control following breast cancer surgery

Lu¹,

Hong²,

Chou³

et al. 2015

TCRM

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IntroductionThis retrospective cohort study evaluated whether education in combination with physiotherapy can reduce the risk of breast cancer-related lymphedema (BCRL).MethodsWe analyzed 1,217 women diagnosed with unilateral breast cancer between January 2007 and December 2011 who underwent tumor resection and axillary lymph node dissection. The patients were divided into three groups: Group A (n=415), who received neither education nor physiotherapy postsurgery; Group B (n=672), who received an educational program on BCRL between Days 0 and 7 postsurgery; and Group C (n=130), who received an educational program on BCRL between Days 0 and 7 postsurgery, followed by a physiotherapy program. All patients were monitored until October 2013 to determine whether BCRL developed. BCRL risk factors were evaluated using Cox proportional hazards models.ResultsDuring the follow-up, 188 patients (15.4%) developed lymphedema, including 77 (18.6%) in Group A, 101 (15.0%) in Group B, and 10 (7.7%) in Group C (P=0.010). The median period from surgery to lymphedema was 0.54 years (interquartile range =0.18–1.78). The independent risk factors for BCRL included positive axillary lymph node invasion, a higher (>20) number of dissected axillary lymph nodes, and having undergone radiation therapy, whereas receiving an educational program followed by physiotherapy was a protective factor against BCRL (hazard ratio =0.35, 95% confidence interval =0.18–0.67, P=0.002).ConclusionPatient education that begins within the first week postsurgery and is followed by physiotherapy is effective in reducing the risk of BCRL in women with breast cancer.

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Factors Associated With Lymphedema in Women With Node-Positive Breast Cancer Treated With Neoadjuvant Chemotherapy and Axillary Dissection

et al. 2019

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IMPORTANCE Most lymphedema studies include a heterogeneous population and focus on patients treated with adjuvant chemotherapy.OBJECTIVE To examine factors associated with lymphedema after neoadjuvant chemotherapy (NAC) and axillary lymph node dissection in women with node-positive breast cancer. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included data from 701 women 18 years or older with cT0-T4N1-2M0 breast cancer with documented axillary nodal metastasis at diagnosis who were enrolled in the American College of Surgeons Oncology Group Z1071 (Alliance for Clinical Trials in Oncology) trial,

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A Model to Estimate the Risk of Breast Cancer-Related Lymphedema: Combinations of Treatment-Related Factors of the Number of Dissected Axillary Nodes, Adjuvant Chemotherapy, and Radiation Therapy

Cited by 90 publications

References 17 publications

Identification of Prognostic Risk Factors for Transient and Persistent Lymphedema after Multimodal Treatment for Breast Cancer

Identification of Prognostic Risk Factors for Transient and Persistent Lymphedema after Multimodal Treatment for Breast Cancer

Role of physiotherapy and patient education in lymphedema control following breast cancer surgery

Factors Associated With Lymphedema in Women With Node-Positive Breast Cancer Treated With Neoadjuvant Chemotherapy and Axillary Dissection

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