Incidence of breast carcinoma-related lymphedema

Petrek, Jeanne A.; Heelan, C B A Melissa

doi:10.1002/(sici)1097-0142(19981215)83:12b+<2776::aid-cncr25>3.0.co;2-v

Cited by 399 publications

(247 citation statements)

References 17 publications

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“…Others, however, have previously reported a similar trend in studies of patients with breast cancer. 6 In summary, cancer-related lymphedema is a common post-treatment condition. All persons undergoing lymph node dissection for the treatment of solid tumors should be considered at lifetime risk for developing lymphedema.…”

Section: Discussionmentioning

confidence: 99%

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Lymphedema beyond breast cancer

Cormier

Askew

Mungovan

et al. 2010

Cancer

413

170

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BACKGROUND: Secondary lymphedema is a debilitating, chronic, progressive condition that commonly occurs after the treatment of breast cancer. The purpose of the current study was to perform a systematic review and meta-analysis of the oncology-related literature excluding breast cancer to derive estimates of lymphedema incidence and to identify potential risk factors among various malignancies. METHODS: The authors systematically reviewed 3 major medical indices (MEDLINE, Cochrane Library databases, and Scopus) to identify studies that included a prospective assessment of lymphedema after cancer treatment. Studies were categorized according to malignancy, and data included treatment, complications, lymphedema measurement criteria, lymphedema incidence, and followup interval. A quality assessment of individual studies was performed using established criteria for systematic reviews. Bayesian meta-analytic techniques were applied to derive summary estimates when sufficient data were available. RESULTS: A total of 47 studies (7779 cancer survivors) met inclusion criteria: melanoma (n ¼ 15), gynecologic malignancies (n ¼ 22), genitourinary cancers (n ¼ 8), head/neck cancers (n ¼ 1), and sarcomas (n ¼ 1). The overall incidence of lymphedema was 15.5% and varied by malignancy (P < .001): melanoma, 16% (upper extremity, 5%; lower extremity, 28%); gynecologic, 20%; genitourinary, 10%; head/neck, 4%; and sarcoma, 30%. Increased lymphedema risk was also noted for patients undergoing pelvic dissections (22%) and radiation therapy (31%). Objective measurement methods and longer follow-up were both associated with increased lymphedema incidence. CONCLUSIONS: Lymphedema is a common condition affecting cancer survivors with various malignancies. The incidence of lymphedema is related to the type and extent of treatment, anatomic location, heterogeneity of assessment methods, and length of follow-up. Cancer 2010;116:5138-49.

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Section: Discussionmentioning

confidence: 99%

“…Only 1 study in this group used objective measurement methods (circumference), whereas the remainder assessed lymphedema subjectively. The length of follow-up ranged from 9 to 115 months, and the median quality score for these studies was 5 (range, [3][4][5][6][7][8][9].…”

Section: Type Of Malignancymentioning

confidence: 99%

Lymphedema beyond breast cancer

Cormier

Askew

Mungovan

et al. 2010

Cancer

413

170

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“…The incidence of lymphedema after lymphadenectomy has been welldescribed in the literature, particularly for breast cancer and melanoma, and is in the range of 10% to 25%. 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).…”

Section: Discussionmentioning

confidence: 99%

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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“…They also noted that comparisons were difficult due to heterogeneity of definition of lymphedema, measurement techniques, etc. [24].…”

Section: Discussionmentioning

confidence: 99%

Study of Incidence of Lymphedema in Indian Patients Undergoing Axillary Dissection for Breast Cancer

Pillai

Sharma

Ahmed

et al. 2010

Indian J Surg Oncol

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Lymphedema of the upper extremity, in addition to being unsightly, can be painful, can limit the arm movements, increases the risk of infection and is psychologically distressing, serving as a constant reminder of cancer. 1. To ascertain the incidence of lymphedema in a hospital based population (in patients undergoing axillary dissection for breast cancer. 2. To determine the clinicoepidemilogical factors associated with the occurrence of lymphedema in these patients. For all patients undergoing axillary dissection, arm measurements were taken in the pre-& post-operative period from at least 3 sites; one in the arm, forearm and wrist (points fixed in reference to fixed bony landmarks). Patients included in this study were followed up for at least 12 months. Circumference difference of more than 5% was taken as mild lymphedema; more than 10% as moderate lymphedema and more than 15% as severe lymphedema. Data was analyzed using SPSS 11.0 statistical software. Of the 231 patients in this study mean age was 51.2 years, majority were housewives (71.9%) and postmenopausal (58.5%). Modified radical mastectomy (MRM), was performed on 203 (87.9%) patients. 57.2% patients had positive lymph nodes. The mean number of positive nodes was 6.52. Majority of the patients received chemo and radio therapy. Overall incidence of lymphedema was 41.1%. The definition of 5-10% increase as mild lymphedema may be a bit severe as in most patients with this increase, lymphedema is not clinically apparent. The incidence of moderate and severe lymphedema in our series is only 7.4%. The incidence of clinically significant lymphedema (moderate to severe lymphedema & symptomatic mild lymphedema) was 16.8%. Only axillary irradiation and pathological nodal status (pN3) emerged as significant risk factors for lymphedema development on multivariate analysis. Lymphedema once established is difficult to treat. Combination of axillary dissection with radiation and more nodal positivity seems to predispose to lymphedema. Prevention by means of sentinel node biopsy in early cases, good surgical technique, arm care post surgery, exercises and massage therapy may help reducing the incidence and/or severity.

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Incidence of breast carcinoma-related lymphedema

Cited by 399 publications

References 17 publications

Lymphedema beyond breast cancer

Lymphedema beyond breast cancer

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

Study of Incidence of Lymphedema in Indian Patients Undergoing Axillary Dissection for Breast Cancer

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