Tackling the diversity of breast cancer related lymphedema: Perspectives on diagnosis, risk assessment, and clinical management

Michelotti, A.; Invernizzi, Marco; Lopez, Gianluca; Lorenzini, Daniele; Nesa, Francesco; Sire, Alessandro de; Fusco, Nicola

doi:10.1016/j.breast.2018.12.009

Cited by 63 publications

(54 citation statements)

References 84 publications

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“…Risk factors can include radiation, large radiation field, conventional fractionation radiation, obesity, age, chemotherapy infusion to the affected limb, taxane-based chemotherapy, advanced stage disease, number of lymph nodes removed, and number of positive lymph nodes. [2,[4][5][6][7][8][9][10][11] Secondary lymphedema can also result from traumatic injury or infections involving the lymphatic tree. Less frequently, secondary lymphedema can develop in patients due to extreme obesity.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

Coriddi

Dayan

Sobti

et al. 2020

Cancers

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Introduction: Analysis of quality of life (QOL) outcomes is an important aspect of lymphedema treatment since this disease can substantially impact QOL in affected individuals. There are a growing number of studies reporting patient-reported outcomes (PROMs) for patients with lymphedema. The purpose of this study was to conduct a systematic review of outcomes and utilization of PROMs following surgical treatment of lymphedema. Methods: A literature search of four databases was performed up to and including March, 2019. Studies included reported on QOL outcomes after physiologic procedures, defined as either lymphovenous bypass (LVB) or vascularized lymph node transplant (VLNT), to treat upper and/or lower extremity primary or secondary lymphedema. Results: In total, 850 studies were screened—of which, 32 studies were included in this review. Lymphovenous bypass was the surgical intervention in 16 studies, VLNT in 11 studies, and both in 5 studies. Of the 32 total studies, 16 used validated survey tools. The most commonly used PROM was the lymph quality of life measure for limb lymphedema (LYMQOL) (12 studies). In the remaining four studies, the upper limb lymphedema 27 scale (ULL27), the short form 36 questionnaire (SF-36), the lymphedema functioning, disability and health questionnaire (Lymph-ICF), and lymphedema life impact scale (LLIS) were each used once. QOL improvement following surgical treatment was noted in all studies. Conclusions: Physiologic surgical treatment of lymphedema results in improved QOL outcomes in most patients. The use of validated PROM tools is increasing but there is no current consensus on use. Future research to evaluate the psychometric properties of PROMs in lymphedema is needed to guide the development and use of lymphedema-specific tools.

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Section: Introductionmentioning

confidence: 99%

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

Coriddi

Dayan

Sobti

et al. 2020

Cancers

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“…The soft tissue composition is a key factor in lymphatic homeostasis, as demonstrated by the increased risk of lymphedema related to fat accumulation (8,42,43). Importantly, the lymphatic fluid stasis regulates the expression of genes with regulatory functions in adipogenesis, such as peroxisome proliferator-activated receptor gamma (PPARG) and CCAAT/enhancer-binding protein alpha (CEBPA) (44).…”

Section: Understanding the Tissue Milieu: Inflammation And Matrix Resmentioning

confidence: 99%

“…A higher prevalence of BCRL has also been observed in patients treated with anti-tumor systemic drugs, such as taxanes and trastuzumab, probably due to diminished lymphatic contractility (59)(60)(61). The correlation between body max index (BMI) >25 kg/m 2 , post-operative weight increase, dyslipidemia, and BCRL has been widely demonstrated (8). However, novel tumor-specific pathological features, such as peritumoral lymphovascular invasion and the extra-nodal extension of the metastatic deposits, have recently been proposed to improve BCRL risk stratification (56,57).…”

Section: Risk Stratification: Who Is Likely To Develop Bcrl?mentioning

confidence: 99%

“…The diagnosis of BCRL is established by the measurement of the arm volume. Over the past decades, a wide variety of strategies have been proposed to identify and quantify alterations in the upper limb volume, including tape, perometry, bioimpedance, imaging (e.g., lymphography and magnetic resonance imaging), and augmented reality tools (5)(6)(7)(8)(9). BCRL prevention is centered on general healthcare suggestions, such as physical activity, body weight control, skincare, avoidance of infections (10).…”

Section: Introductionmentioning

confidence: 99%

“…However, microsurgery-based primary prevention schemes, such as axillary reverse mapping and lymphatic-venous bypass, are showing promising results (11). For decades BCRL has been considered as an incurable condition but several therapeutic approaches are now available, both in the setting of physical therapy (e.g., complex decongestive therapy, manual lymph drainage, Qigong exercise, yoga, laser therapy, extracorporeal, shock wave therapy) and surgery (e.g., tissue excision, derivative microsurgery, microsurgical reconstruction, vascularized lymph node transfer, block of sympathetic innervation) (8,(12)(13)(14)(15). Regrettably, the pre-surgical identification of high-risk individuals is extremely challenging.…”

Section: Introductionmentioning

confidence: 99%

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Integrating Biological Advances Into the Clinical Management of Breast Cancer Related Lymphedema

et al. 2020

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Breast cancer-related lymphedema (BCRL) occurs in a significant number of breast cancer survivors as a consequence of the axillary lymphatics' impairment after therapy (mainly axillary surgery and irradiation). Despite the recent achievements in the clinical management of these patients, BCRL is often diagnosed at its occurrence. In most cases, it remains a progressive and irreversible condition, with dramatic consequences in terms of quality of life and on sanitary costs. There are still no validated pre-surgical strategies to identify individuals that harbor an increased risk of BCRL. However, clinical, therapeutic, and tumor-specific traits are recurrent in these patients. Over the past few years, many studies have unraveled the complexity of the molecular and transcriptional events leading to the lymphatic system ontogenesis. Additionally, molecular insights are coming from the study of the germline alterations involved at variable levels in BCRL models. Regrettably, there is a substantial lack of predictive biomarkers for BCRL, given that our knowledge of its molecular milieu remains extremely puzzled. The purposes of this review were (i) to outline the biology underpinning the ontogenesis of the lymphatic system; (ii) to assess the current state of knowledge of the molecular alterations that can be involved in BCRL pathogenesis and progression; (iii) to discuss the present and shortterm future perspectives in biomarker-based patients' risk stratification; and (iv) to provide practical information that can be employed to improve the quality of life of these patients.

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The sequelae of mastectomy and quadrantectomy with respect to the reaching movement in breast cancer survivors: evidence for an integrated rehabilitation protocol during oncological care

Paolucci

Bernetti

Bai

et al. 2020

Support Care Cancer

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Tackling the diversity of breast cancer related lymphedema: Perspectives on diagnosis, risk assessment, and clinical management

Cited by 63 publications

References 84 publications

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

Integrating Biological Advances Into the Clinical Management of Breast Cancer Related Lymphedema

The sequelae of mastectomy and quadrantectomy with respect to the reaching movement in breast cancer survivors: evidence for an integrated rehabilitation protocol during oncological care

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