Full axillary lymph node dissection and increased breast epidermal thickness 1 year after radiation therapy for breast cancer

Abstract

Background We previously reported a prospective study showing axillary lymph node dissection (ALND) is associated with increased breast skin thickening during and 6 weeks post‐radiation therapy (RT), and now report ALND's long‐term impact at 1 year. Methods Among 66 women who received whole breast RT after lumpectomy, objective ultrasound measurements of epidermal thickness over four quadrants of the treated breast were measured at five time points: before RT, week 6 of RT, and 6 weeks, 6 months, and 1 year post‐RT. Skin thickness ratio (STRA) was generated by normalizing for corresponding measurements of the contralateral breast. Results A total of 2,436 ultrasound images were obtained. Among 63 women with evaluable data at 1 year, mean STRA significantly increased at 6 months (absolute mean increase of 65%, SD 0.054), and remained elevated at 1 year post‐RT (absolute mean increase of 44%, SD 0.048). In multivariable analysis, ALND compared to sentinel lymph node biopsy, longer interval between surgery and RT, increased baseline STRA, and Caucasian race predicted for more severe changes in STRA at 1 year compared to baseline (all P < .05). Conclusions In the setting of whole breast RT, our findings suggest that ALND has long‐term repercussions on breast skin thickening.

Ultrasonographic Evaluation of Skin Toxicity Following Radiotherapy of Breast Cancer: A Systematic Review

“…The selected studies were published between 1998 and 2021 and were geographically diverse, representing eight countries. A total of 6/17 studies were conducted in the same centre in the USA (Emory University School of Medicine), almost by the same group of authors [ 9 , 31 , 32 , 33 , 34 , 35 ]. One of these studies [ 9 ] was a more comprehensive follow-up study with 77% of the patients from the previous one [ 32 ].…”

“…A total of 6/17 studies were conducted in the same centre in the USA (Emory University School of Medicine), almost by the same group of authors [ 9 , 31 , 32 , 33 , 34 , 35 ]. One of these studies [ 9 ] was a more comprehensive follow-up study with 77% of the patients from the previous one [ 32 ]. Lastly, three studies were conducted by the same author in Newcastle Mater Hospital, Waratah, NSW, Australia [ 36 , 37 , 38 ].…”

“…The age range of the reported studies was between 26 to79 years. The BMI (mean and median range 23.5–29.9) of the patients was reported in five studies [ 9 , 32 , 33 , 39 , 41 ], and smoking history was reported in three studies [ 9 , 32 , 41 ] ( n = 12/66, 14/70, and 2/34 patients, respectively). In addition, breast volume (range 177–6988.3 cm 3 or mL) was reported in five studies [ 9 , 32 , 33 , 41 , 45 ].…”

“…Chronic or late skin toxicity symptoms such as telangiectasia, hypo- or hyperpigmentation, and fibrosis are less common in severity. However, they affect the cosmetic appearance of the breast and impact women’s self-image [ 9 ]. The pathophysiology of radiation-induced skin toxicity includes factors such as inducing inflammation and the release of inflammatory mediators [ 10 ].…”

Extended Hypofractionated Cancer Radiation Therapy Against Aged and Non-aged Breast Carcinomas Patients

“…In women with bosom malignant growth who go through bosom rationing a medical procedure [1], [2], entire bosom illumination diminishes the danger of neighborhood repeat and forestall requirement for mastectomy [3]- [5]. An upgradation of a meta-investigation showed that bosom light after bosom saving a medical procedure lessens mortality from bosom cancer [6], [7] However, up to 30% of ladies in North America who go through bosom preserving a medical procedure do not go through bosom illumination, partially in view of the burden of the treatment and its cost [7], [8].…”