Impact of adjuvant taxane-based chemotherapy on development of breast cancer-related lymphedema: results from a large prospective cohort

Abstract

Taxane-based chemotherapy for the treatment of breast cancer is associated with fluid retention in the extremities; however, its association with development of breast cancer-related lymphedema is unclear. We sought to determine if adjuvant taxane-based chemotherapy increased risk of lymphedema or mild swelling of the upper extremity. 1121 patients with unilateral breast cancer were prospectively screened for lymphedema with perometer measurements. Lymphedema was defined as a relative volume change (RVC) of ≥10 % from preoperative baseline. Mild swelling was defined as RVC 5- <10 %. Clinicopathologic characteristics were obtained via medical record review. Kaplan–Meier and Cox proportional hazard analyses were performed to determine lymphedema rates and risk factors. 29 % (324/1121) of patients were treated with adjuvant taxane-based chemotherapy. The 2-year cumulative incidence of lymphedema in the overall cohort was 5.27 %. By multivariate analysis, axillary lymph node dissection (ALND) (p < 0.0001), higher body mass index (p = 0.0007), and older age at surgery (p = 0.04) were significantly associated with increased risk of lymphedema; however, taxane chemotherapy was not significant when compared to no chemotherapy and non-taxane chemotherapy (HR 1.14, p = 0.62; HR 1.56, p = 0.40, respectively). Chemotherapy with docetaxel was significantly associated with mild swelling on multivariate analysis in comparison to both no chemotherapy and non-taxane chemotherapy groups (HR 1.63, p = 0.0098; HR 2.15, p = 0.02, respectively). Patients who receive taxane-based chemotherapy are not at an increased risk of lymphedema compared to patients receiving no chemotherapy or non-taxane adjuvant chemotherapy. Those treated with docetaxel may experience mild swelling, but this does not translate into subsequent lymphedema.

Lymphedema after treatment of breast cancer: a comprehensive review

“…These findings were also supported by Zhu et al [52] who also found a correlation between taxanebased adjuvant chemotherapy and the cumulative incidence of BCRL. Conversely, Swaroop et al [54] did not find any correlation between taxane-based chemotherapy and the development of BCRL, however there was some correlation between docetaxol to be a risk factor for mild swelling compared to no chemotherapy and non-taxane based chemotherapy. While there are new studies looking at neoadjuvant therapy as a risk factor for the development of BCRL, the findings are inconclusive.…”

Lymphedema in survivors of breast cancer (Review)

“…Other studies have shown that age is not associated with BCRL (32,33). It was demonstrated that women treated with chemotherapy, specifically with taxane-based chemotherapy were more likely to develop lymphedema (34,35), but with inconsistent results (36). Extreme temperature and hypertension are risk factors for BCRL that have been confirmed in certain studies (37,38), however, further investigation is required.…”

The Lymphatic System in Disease Processes and Cancer Progression

“…The incidence of cancer-related secondary lymphedema after lymph node dissection and/or sentinel lymph node biopsy can be as high as 63.4%, and this condition commonly results from treatments that include surgical intervention, radiation therapy, chemotherapy, hormonal therapy, and/or targeted therapy (174, 183). Notably, a prospective study with 1,121 patients showed that taxane-based therapy does not increase the risk of developing lymphedema (184). …”