Chronic Arm Morbidity After Curative Breast Cancer Treatment: Prevalence and Impact on Quality of Life

Kwan, Winkle; Jackson, Jeremy S. H.; Weir, Lorna; Dingee, Carol; McGregor, Gregor I.; Olivotto, Ivo A.

doi:10.1200/jco.2002.09.018

Cited by 306 publications

(221 citation statements)

References 17 publications

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“…35,36 The addition of radiotherapy to lymph node dissection can substantially increase the risk to as high as 38% to 77% [37][38][39][40] and has been shown to negatively impact quality of life. 41,42 In this series, 7 patients developed lymphedema (3 patients were treated with CLND and 4 patients with CLND followed by adjuvant radiation). No patients who received lymph node irradiation alone developed lymphedema, despite a similar distribution of affected lymph node basins.…”

Section: Discussionmentioning

confidence: 89%

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Fang

Lemos

Douglas

et al. 2010

Cancer

145

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BACKGROUND:Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high risk of lymph node involvement. To the authors' knowledge, few data have been published to date regarding the optimal regional therapy for lymph node‐positive patients. This cohort study was performed to analyze the outcomes of patients with lymph node‐positive MCC treated with lymph node irradiation as definitive therapy compared with completion lymphadenectomy (CLND).METHODS:Fifty patients with lymph node involvement of MCC at presentation and adequate follow‐up data were included in this analysis. Forty‐three of these patients were enrolled and followed prospectively. Twenty‐six patients presented with microscopic lymph node disease, and 24 patients presented with palpable lymph node involvement.RESULTS:Regional control for patients with microscopically involved lymph nodes was 100% regardless of treatment modality—definitive lymph node irradiation (n = 19) or CLND ± radiotherapy (n = 7) with median follow‐up of 18 months. Patients with clinically positive lymph nodes had 2‐year regional recurrence‐free survival rate of 78% and 73% in the definitive lymph node irradiation (n = 9) and CLND ± radiotherapy (n = 15) groups, respectively (P = .8) with a median follow‐up of 16 months.CONCLUSIONS:To the best of the authors' knowledge, the current study is the largest series published to date of radiation monotherapy as regional treatment for lymph node‐positive MCC. Lymph node irradiation alone to positive regional lymph nodes was found to confer an excellent regional control rate that was comparable to CLND for both microscopic and palpable lymph node disease. There was no difference noted with regard to overall survival. Given their similar efficacy, the choice between these lymph node therapies may be based on the clinical scenario and anticipated side effect profiles. Cancer 2010. © 2010 American Cancer Society.

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Section: Discussionmentioning

confidence: 89%

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Fang

Lemos

Douglas

et al. 2010

Cancer

145

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“…Meme kanserine yönelik bölgesel tedavi lenfödem, omuzda ağrı ve hareket kısıtlılığı ile sonuçlanabilmektedir. Tanıdan beş yıla kadar olan takiplerde %38 hastada kol problemleri mevcut olup (2), hastaların günlük yaşamları önemli derecede etkilenmekte ve bu hastalarda yaşam kalitesi daha düşük bulunmaktadır (3).…”

Section: Introductionunclassified

“…Yapılan literatür taramasında, üst ekstremiteye ait semptomatolojiler olan lenfödem, omuzda ağrı ve omuzda hareket kısıtlılığının yaşam kalitesi üzerine etkisini farklı ölçeklerle araştıran çalışmalar olmakla birlikte (3,7,9,14) WHOQOL-BREF TR ile yaşam kalitesi üzerine etkisini araştıran çalışmaya rastlanmamıştır.…”

Section: Introductionunclassified

Meme Cerrahisi ve Aksiller Diseksiyon Uygulanan Meme Kanserli Hastalarda Üst Ekstremite Problemlerinin Sıklığı ve Yaşam Kalitesine Etkisi

Atalay¹

2013

Tftr

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Sum maryAim: The purpose of this study was to determine the prevalence of upper extremity problems in patients who had undergone breast cancer surgery, to compare the risk factors associated with these problems and to investigate their effects on quality of life. Materials and Methods: One hundred thirty-two patients who had undergone either modified radical mastectomy or breast conserving surgery (lumpectomy) were enrolled to the study. Lymphedema, shoulder pain and restriction of shoulder motion were considered as upper extremity problems. Type of surgery, body mass index (BMI), radiotherapy, chemotherapy, disease stage and dominant hand involvement were recorded. The World Health Organisation (WHO) Quality of Life-BREF-Turkish Version (WHOQOL-BREF-TR) was used for the assessment of quality of life. Results: Shoulder pain was the most common symptom (45.5%), followed by lymphedema (34.8%) and shoulder motion restriction (22%). No significant relation was found between lymphedema and age, type of surgery, restriction of shoulder motion, pain and dominant hand involvement. Increased BMI, treatment with chemotherapy or radiotherapy, advanced-disease stage and lymph node involvement were associated with lymphedema (p< 0.05). It was seen that doing regular exercise had positive effect on lymphedema, pain and shoulder motion restriction reduction ( p<0.05). Lymphedema, pain and shoulder motion restriction were related with physical and psychological subgroups of WHOQOL-BREF TR, whereas shoulder motion restriction was also associated with the environmental subgroup (p<0.05). When Özet Amaç: Bu çalışmanın amacı meme kanseri nedeniyle cerrahi uygulanan hastalarda üst ekstremite problemlerinin görülme sıklığının saptanması, bu problemlerle ilişkili risk faktörlerinin karşılaştırılması ve yaşam kalitesi üzerine etkilerini araştırmaktır. Gereç ve Yöntem: Modifiye radikal mastektomi veya meme koruyucu cerrahi (lumpektomi) uygulanan 132 hasta çalışmaya dahil edildi. Üst ekstremite problemleri olarak lenfödem, omuz ağrısı, omuz hareket kısıtlılığı değerlendirildi. Ayrıca operasyon şekli, vücut kitle indeksi (VKİ), kemoterapi (KT), radyoterapi (RT), hastalık evresi, lenf nodu tutulumu, yaş, dominant elin tutulumu kaydedildi. Yaşam kalitesi ölçeği olarak Dünya Sağlık Örgütü Yaşam Kalitesi Ölçeği Türkçe kısa formu (WHOQOL-BREF TR) kullanıldı. Bulgular: Hastalarda en sık görülen semptom olan omuzda ağrıyı (%45,5), lenfödem (%34,8) ve omuzda hareket kısıtlılığı (%22) takip etmekteydi. Yaş, operasyon şekli, omuzda hareket kısıtlılığı, ağrı varlığı ve dominant elin tutulumu ile lenfödem arasında anlamlı ilişki saptanmazken, artmış VKİ, KT-RT tedavisi almış olma, ileri hastalık evresi, lenf nodu tutulumu varlığı lenfödem olan grupta daha yüksekti (p<0,05). Düzenli egzersiz yapmanın lenfödem, ağrı ve hareket kısıtlılığını azaltma yönünde etkili bir faktör olduğu görüldü (p<0,05). Lenfödem, ağrı ve omuz hareket kısıtlılığının WHOQOL-BREF TR'nin bedensel, ruhsal alt alanları üzerine, omuz hareket kısıtlılığının ayrıca çevre alt alanı ü...

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“…Fibrosis and sclerosis of the dermal structures and hypertrophy of subcutaneous adipose tissue are the morphologic correlate of irreversible lymphedema [5,6]. Although the introduction of sentinel lymph node biopsy has reduced postoperative complications after cancer treatment, secondary lymphedema is still one of the major complications, e.g., after breast cancer treatment, in particular when the axillary lymph nodes have to be removed in combination with radiotherapy [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Effects of autotransplanted lymph node fragments on the lymphatic system in the pig model

Blum

Hadamitzky

Gratz

et al. 2009

Breast Cancer Res Treat

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Secondary lymphedema often develops after removal of lymph nodes in combination with radiation therapy, in particular in patients with breast cancer, inguinal cancer, cervical cancer and melanoma. No convincing treatment for the prevention and therapy of acquired lymphedema exists so far, therefore we wanted to show the reintegration of transplanted avascular lymph node fragments in the lymphatic system and positive effects of the transplanted fragments on the restoration of the lymphatic flow in this study. A total of 26 minipigs underwent lymphadenectomy of both groins. A minimum of one lymph node was retransplanted. The lymph nodes were cut into small pieces and retransplanted in the left groin (n = 17) or in both groins (n = 9). Different retransplantation techniques were investigated, transplantation of large versus small fragments, with and without capsule. The lymph flow was evaluated 5 and 8 months after surgery, using SPECT/CT and Berlin Blue. The results were confirmed by dissection. The lymph node transplants were assessed histologically. In contrast to the lymph flow in the transplanted groin, the lymph flow in the non-transplanted groin was often malfunctioning. Large lymph node fragments were found reintegrated in the lymphatic system more often than small slices of lymph node fragments. About 5 months after surgery impairment of lymph flow was seen especially after retransplantation of small slices of lymph node fragments. In seven out of eight minipigs a dermal backflow developed in the non-transplanted groin, 8 months after surgery. Only one minipig of these groups developed dermal backflow in both groins. All lymph node fragments showed an organized structure histologically. Autologous lymph node transplantation has positive effects on the regeneration of lymph vessels and restoration of lymph flow after lymphadenectomy.

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Chronic Arm Morbidity After Curative Breast Cancer Treatment: Prevalence and Impact on Quality of Life

Abstract: Treatment for breast cancer is associated with considerable arm morbidity, which has a negative impact on QOL. Arm morbidity should be carefully monitored in future studies involving local treatment modalities for breast cancer.

Cited by 306 publications

References 17 publications

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Meme Cerrahisi ve Aksiller Diseksiyon Uygulanan Meme Kanserli Hastalarda Üst Ekstremite Problemlerinin Sıklığı ve Yaşam Kalitesine Etkisi

Effects of autotransplanted lymph node fragments on the lymphatic system in the pig model

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