The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: A prospective cohort study
Identifieur interne : 002417 ( Main/Exploration ); précédent : 002416; suivant : 002418The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: A prospective cohort study
Auteurs : Laura E. G. Warren ; Cynthia L. Miller ; Nora Horick ; Melissa N. Skolny ; Lauren S. Jammallo ; Betro T. Sadek ; Mina N. Shenouda ; Jean A. O Oole ; Shannon M. Macdonald ; Michelle C. Specht ; Alphonse G. TaghianSource :
- International journal of radiation oncology, biology, physics [ 0360-3016 ] ; 2014.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Aisselle, Analyse de variance, Facteurs de risque, Femelle, Humains, Incidence, Indice de masse corporelle, Irradiation ganglionnaire (effets indésirables), Jeune adulte, Lymphadénectomie (effets indésirables), Lymphoedème (diagnostic), Lymphoedème (épidémiologie), Lymphoedème (étiologie), Maladies du sein (diagnostic), Maladies du sein (épidémiologie), Maladies du sein (étiologie), Sujet âgé, Sujet âgé de 80 ans ou plus, Tumeurs du sein (), Tumeurs du sein (radiothérapie), Études prospectives.
- MESH :
- diagnostic : Lymphoedème, Maladies du sein.
- effets indésirables : Irradiation ganglionnaire, Lymphadénectomie.
- radiothérapie : Tumeurs du sein.
- épidémiologie : Lymphoedème, Maladies du sein.
- étiologie : Lymphoedème, Maladies du sein.
- Adulte, Adulte d'âge moyen, Aisselle, Analyse de variance, Facteurs de risque, Femelle, Humains, Incidence, Indice de masse corporelle, Jeune adulte, Sujet âgé, Sujet âgé de 80 ans ou plus, Tumeurs du sein, Études prospectives.
English descriptors
- KwdEn :
- Adult, Aged, Aged, 80 and over, Analysis of Variance, Axilla, Body Mass Index, Breast Diseases (diagnosis), Breast Diseases (epidemiology), Breast Diseases (etiology), Breast Neoplasms (radiotherapy), Breast Neoplasms (surgery), Female, Humans, Incidence, Lymph Node Excision (adverse effects), Lymphatic Irradiation (adverse effects), Lymphedema (diagnosis), Lymphedema (epidemiology), Lymphedema (etiology), Middle Aged, Prospective Studies, Risk Factors, Young Adult.
- MESH :
- adverse effects : Lymph Node Excision, Lymphatic Irradiation.
- diagnosis : Breast Diseases, Lymphedema.
- epidemiology : Breast Diseases, Lymphedema.
- etiology : Breast Diseases, Lymphedema.
- radiotherapy : Breast Neoplasms.
- surgery : Breast Neoplasms.
- Adult, Aged, Aged, 80 and over, Analysis of Variance, Axilla, Body Mass Index, Female, Humans, Incidence, Middle Aged, Prospective Studies, Risk Factors, Young Adult.
Abstract
Lymphedema following breast cancer treatment can be an irreversible condition with a negative impact on quality of life. The goal of this study was to identify radiotherapy-related risk factors for lymphedema.
From 2005–2012, we prospectively performed arm volume measurements on 1,476 breast cancer patients at our institution using a Perometer. Treating each breast individually, 1099/1501 (73%) received radiotherapy. Arm measurements were performed pre- and post-operatively. Lymphedema was defined as ≥10% arm volume increase occurring >3 months post-operative. Univariate and multivariate Cox proportional hazard models were used to evaluate risk factors for lymphedema.
At a median follow-up of 25.4 months (range 3.4–82.6), the 2-year cumulative incidence of lymphedema was 6.8%. Cumulative incidence by radiotherapy type was: 3.0% (no radiotherapy), 3.1% (breast or chest wall alone), 21.9% (supraclavicular (SC)), and 21.1% (SC and posterior axillary boost (PAB)). On multivariate analysis, the hazard ratio for RLNR (SC±PAB) was 1.7 (p = 0.025) compared to breast/chest wall radiation alone. There was no difference in lymphedema risk between SC and SC+PAB (p=0.96). Other independent risk factors included early post-operative swelling (p <0.0001), higher BMI (p<0.0001), greater number of lymph nodes dissected (p =0.018), and axillary lymph node dissection (p=0.0001).
In a large cohort of breast cancer patients prospectively screened for lymphedema, RLNR significantly increased risk of lymphedema compared to breast/chest wall radiation alone. When considering use of RLNR, clinicians should weigh the potential benefit of RLNR for control of disease with the increased risk of lymphedema.
Url:
DOI: 10.1016/j.ijrobp.2013.11.232
PubMed: 24411624
PubMed Central: 3928974
Affiliations:
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G." last="Warren">Laura E. G. Warren</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff><wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry></affiliation></author><author><name sortKey="Miller, Cynthia L" sort="Miller, Cynthia L" uniqKey="Miller C" first="Cynthia L." last="Miller">Cynthia L. Miller</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff><wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry></affiliation></author><author><name sortKey="Horick, Nora" sort="Horick, Nora" uniqKey="Horick N" first="Nora" last="Horick">Nora Horick</name><affiliation><nlm:aff id="A2">Department of Biostatistics, Massachusetts General Hospital</nlm:aff><wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry></affiliation></author><author><name sortKey="Skolny, Melissa N" sort="Skolny, Melissa N" uniqKey="Skolny M" first="Melissa N." last="Skolny">Melissa N. Skolny</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff><wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry></affiliation></author><author><name sortKey="Jammallo, Lauren S" sort="Jammallo, Lauren S" uniqKey="Jammallo L" first="Lauren S." last="Jammallo">Lauren S. Jammallo</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff><wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry></affiliation></author><author><name sortKey="Sadek, Betro T" sort="Sadek, Betro T" uniqKey="Sadek B" first="Betro T." last="Sadek">Betro T. Sadek</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff><wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry></affiliation></author><author><name sortKey="Shenouda, Mina N" sort="Shenouda, Mina N" uniqKey="Shenouda M" first="Mina N." last="Shenouda">Mina N. Shenouda</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff><wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry></affiliation></author><author><name sortKey="O Oole, Jean A" sort="O Oole, Jean A" uniqKey="O Oole J" first="Jean A." last="O Oole">Jean A. O Oole</name><affiliation><nlm:aff id="A3">Department of Physical and Occupational Therapy, Massachusetts General Hospital</nlm:aff><wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry></affiliation></author><author><name sortKey="Macdonald, Shannon M" sort="Macdonald, Shannon M" uniqKey="Macdonald S" first="Shannon M." last="Macdonald">Shannon M. Macdonald</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff><wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry></affiliation></author><author><name sortKey="Specht, Michelle C" sort="Specht, Michelle C" uniqKey="Specht M" first="Michelle C." last="Specht">Michelle C. Specht</name><affiliation><nlm:aff id="A4">Division of Surgical Oncology, Massachusetts General Hospital</nlm:aff><wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry></affiliation></author><author><name sortKey="Taghian, Alphonse G" sort="Taghian, Alphonse G" uniqKey="Taghian A" first="Alphonse G." last="Taghian">Alphonse G. Taghian</name><affiliation><nlm:aff id="A1">Department of Radiation Oncology, Massachusetts General Hospital</nlm:aff><wicri:noCountry code="subfield">Massachusetts General Hospital</wicri:noCountry></affiliation></author></analytic><series><title level="j">International journal of radiation oncology, biology, physics</title><idno type="ISSN">0360-3016</idno><idno type="eISSN">1879-355X</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Analysis of Variance</term><term>Axilla</term><term>Body Mass Index</term><term>Breast Diseases (diagnosis)</term><term>Breast Diseases (epidemiology)</term><term>Breast Diseases (etiology)</term><term>Breast Neoplasms (radiotherapy)</term><term>Breast Neoplasms (surgery)</term><term>Female</term><term>Humans</term><term>Incidence</term><term>Lymph Node Excision (adverse effects)</term><term>Lymphatic Irradiation (adverse effects)</term><term>Lymphedema (diagnosis)</term><term>Lymphedema (epidemiology)</term><term>Lymphedema (etiology)</term><term>Middle Aged</term><term>Prospective Studies</term><term>Risk Factors</term><term>Young Adult</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Aisselle</term><term>Analyse de variance</term><term>Facteurs de risque</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Indice de masse corporelle</term><term>Irradiation ganglionnaire (effets indésirables)</term><term>Jeune adulte</term><term>Lymphadénectomie (effets indésirables)</term><term>Lymphoedème (diagnostic)</term><term>Lymphoedème (épidémiologie)</term><term>Lymphoedème (étiologie)</term><term>Maladies du sein (diagnostic)</term><term>Maladies du sein (épidémiologie)</term><term>Maladies du sein (étiologie)</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Tumeurs du sein ()</term><term>Tumeurs du sein (radiothérapie)</term><term>Études prospectives</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Lymph Node Excision</term><term>Lymphatic Irradiation</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Breast Diseases</term><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Lymphoedème</term><term>Maladies du sein</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Irradiation ganglionnaire</term><term>Lymphadénectomie</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Breast Diseases</term><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Breast Diseases</term><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="radiotherapy" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="radiothérapie" xml:lang="fr"><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Lymphoedème</term><term>Maladies du sein</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Lymphoedème</term><term>Maladies du sein</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Analysis of Variance</term><term>Axilla</term><term>Body Mass Index</term><term>Female</term><term>Humans</term><term>Incidence</term><term>Middle Aged</term><term>Prospective Studies</term><term>Risk Factors</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Aisselle</term><term>Analyse de variance</term><term>Facteurs de risque</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Indice de masse corporelle</term><term>Jeune adulte</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Tumeurs du sein</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Purpose/Objective</title><p id="P2">Lymphedema following breast cancer treatment can be an irreversible condition with a negative impact on quality of life. The goal of this study was to identify radiotherapy-related risk factors for lymphedema.</p></sec><sec id="S2"><title>Methods and Materials</title><p id="P3">From 2005–2012, we prospectively performed arm volume measurements on 1,476 breast cancer patients at our institution using a Perometer. Treating each breast individually, 1099/1501 (73%) received radiotherapy. Arm measurements were performed pre- and post-operatively. Lymphedema was defined as ≥10% arm volume increase occurring >3 months post-operative. Univariate and multivariate Cox proportional hazard models were used to evaluate risk factors for lymphedema.</p></sec><sec id="S3"><title>Results</title><p id="P4">At a median follow-up of 25.4 months (range 3.4–82.6), the 2-year cumulative incidence of lymphedema was 6.8%. Cumulative incidence by radiotherapy type was: 3.0% (no radiotherapy), 3.1% (breast or chest wall alone), 21.9% (supraclavicular (SC)), and 21.1% (SC and posterior axillary boost (PAB)). On multivariate analysis, the hazard ratio for RLNR (SC±PAB) was 1.7 (p = 0.025) compared to breast/chest wall radiation alone. There was no difference in lymphedema risk between SC and SC+PAB (p=0.96). Other independent risk factors included early post-operative swelling (p <0.0001), higher BMI (p<0.0001), greater number of lymph nodes dissected (p =0.018), and axillary lymph node dissection (p=0.0001).</p></sec><sec id="S4"><title>Conclusions</title><p id="P5">In a large cohort of breast cancer patients prospectively screened for lymphedema, RLNR significantly increased risk of lymphedema compared to breast/chest wall radiation alone. When considering use of RLNR, clinicians should weigh the potential benefit of RLNR for control of disease with the increased risk of lymphedema.</p></sec></div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Horick, Nora" sort="Horick, Nora" uniqKey="Horick N" first="Nora" last="Horick">Nora Horick</name><name sortKey="Jammallo, Lauren S" sort="Jammallo, Lauren S" uniqKey="Jammallo L" first="Lauren S." last="Jammallo">Lauren S. Jammallo</name><name sortKey="Macdonald, Shannon M" sort="Macdonald, Shannon M" uniqKey="Macdonald S" first="Shannon M." last="Macdonald">Shannon M. Macdonald</name><name sortKey="Miller, Cynthia L" sort="Miller, Cynthia L" uniqKey="Miller C" first="Cynthia L." last="Miller">Cynthia L. Miller</name><name sortKey="O Oole, Jean A" sort="O Oole, Jean A" uniqKey="O Oole J" first="Jean A." last="O Oole">Jean A. O Oole</name><name sortKey="Sadek, Betro T" sort="Sadek, Betro T" uniqKey="Sadek B" first="Betro T." last="Sadek">Betro T. Sadek</name><name sortKey="Shenouda, Mina N" sort="Shenouda, Mina N" uniqKey="Shenouda M" first="Mina N." last="Shenouda">Mina N. Shenouda</name><name sortKey="Skolny, Melissa N" sort="Skolny, Melissa N" uniqKey="Skolny M" first="Melissa N." last="Skolny">Melissa N. Skolny</name><name sortKey="Specht, Michelle C" sort="Specht, Michelle C" uniqKey="Specht M" first="Michelle C." last="Specht">Michelle C. Specht</name><name sortKey="Taghian, Alphonse G" sort="Taghian, Alphonse G" uniqKey="Taghian A" first="Alphonse G." last="Taghian">Alphonse G. Taghian</name><name sortKey="Warren, Laura E G" sort="Warren, Laura E G" uniqKey="Warren L" first="Laura E. G." last="Warren">Laura E. G. Warren</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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