Risk of lymphoedema following the treatment of breast cancer

Abstract

The incidence of lymphoedema was studied in 200 patients following a variety of treatments for operable breast cancer. Lymphoedema was assessed in two ways: subjective (patient plus observer impression) and objective (physical measurement). Arm volume measurement 15 cm above the lateral epicondyle was the most accurate method of assessing differences in size of the operated and normal arm. Arm circumference measurements were inaccurate. Subjective lymphoedema was present in 14 per cent whereas objective lymphoedema (a difference in limb volume greater than 200 ml) was present in 25.5 per cent. Independent risk factors contributing towards the development of subjective late lymphoedema were the extent of axillary surgery (P less than 0.05), axillary radiotherapy (P less than 0.001) and pathological nodal status (P less than 0.10). The risk of developing late lymphoedema was unrelated to age, menopausal status, handedness, early lymphoedema, surgical and radiotherapeutic complications, total dose of radiation, time interval since presentation, drug therapy, surgery to the breast, radiotherapy to the breast and tumour T stage. The incidence of subjective late lymphoedema was similar after axillary radiotherapy alone (8.3 per cent), axillary sampling plus radiotherapy (9.1 per cent) and axillary clearance alone (7.4 per cent). The incidence after axillary clearance plus radiotherapy was significantly greater (38.3 per cent, P less than 0.001). Axillary radiotherapy should be avoided in patients who have had a total axillary clearance.

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

“…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).…”

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

“…However some authors have noted that that the extent or level of axillary node dissection does not show statistically significant association with the risk of development of lymphedema [18,31]. Postoperative radiotherapy (and its sequelae) increase the risk of and aggravate lymphedema [13,28,29] although not all will agree [12]. Edwards et al studied the incidence of lymphedema after breast cancer treatment by volumetric method and subjective assessment of swelling and found no significant relationship between axillary irradiation and lymphedema [12].…”

“…Edwards et al studied the incidence of lymphedema after breast cancer treatment by volumetric method and subjective assessment of swelling and found no significant relationship between axillary irradiation and lymphedema [12]. Apart from surgery and radiotherapy various other risk factors for lymphedema development are described in literature including age, presence of co-morbid conditions, wound infection, obesity, stage of disease and systemic therapy [13][14][15].…”

“…The incidence of lymphedema has been reported with a very wide range from 2%-40% in women treated with modified radical mastectomy or breast conserving surgery with no apparent difference between the two surgeries [4,5,[8][9][10][11]. The factors quoted to influence incidence of lymphedema include the level of nodal dissection, the number of nodes removed, the number of involved nodes, presence of extra capsular spread, size and grade of the primary tumor, co-morbid conditions, anthracycline based chemotherapy, axillary irradiation, experience of the surgeon, dominant limb and body mass index [12][13][14][15][16].…”

Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients

“…Axillary lymph node dissection (ALND) in breast cancer patients still represents the routine surgical method for axillary staging. Although the axillary node status is the most important prognostic factor for recurrence and survival (Fisher et al, 1984;Carter et al, 1989) and information obtained by axillary dissection is useful for planning adjuvant treatment, it is associated with substantial morbidity (Kissin et al, 1986;Ivens et al, 1992;Keramopoulos et al, 1993;Hack et al, 1999;Kakuda et al, 1999) and psychological distress (Maunsell et al, 1993;Tobin et al, 1993;Shimozuma et al, 1999). Hack et al, showed arm/shoulder pain, weakness or numbness in 72% and impaired range of motion in 73% of breast cancer patients after ALND, whereas high levels of quality of life (QOL) were reported.…”