LymphedemaV1, Main, Exploration, bibRecord, 002564

Risk of lymphedema after mastectomy – potential benefit of applying ACOSOG Z0011 protocol to mastectomy patients

Identifieur interne : 002564 ( Main/Exploration ); précédent : 002563; suivant : 002565

Risk of lymphedema after mastectomy – potential benefit of applying ACOSOG Z0011 protocol to mastectomy patients

Auteurs : Cynthia L. Miller ; Michelle C. Specht ; Melissa N. Skolny ; Nora Horick ; Lauren S. Jammallo ; Jean O Oole ; Mina N. Shenouda ; Betro T. Sadek ; Barbara L. Smith ; Alphonse G. Taghian

Source :

Breast cancer research and treatment [ 0167-6806 ] ; 2014.

RBID : PMC:4011490

Descripteurs français

KwdFr :
- Adulte, Adulte d'âge moyen, Biopsie de noeud lymphatique sentinelle (effets indésirables), Facteurs de risque, Femelle, Humains, Incidence, Jeune adulte, Lymphoedème (épidémiologie), Mastectomie (effets indésirables), Modèles de hasards proportionnels, Protocoles antinéoplasiques, Radiothérapie (effets indésirables), Sujet âgé, Sujet âgé de 80 ans ou plus, Tumeurs du sein (), Tumeurs du sein (radiothérapie).
MESH :
- effets indésirables : Biopsie de noeud lymphatique sentinelle, Mastectomie, Radiothérapie.
- radiothérapie : Tumeurs du sein.
- épidémiologie : Lymphoedème.
- Adulte, Adulte d'âge moyen, Facteurs de risque, Femelle, Humains, Incidence, Jeune adulte, Modèles de hasards proportionnels, Protocoles antinéoplasiques, Sujet âgé, Sujet âgé de 80 ans ou plus, Tumeurs du sein.

English descriptors

KwdEn :
- Adult, Aged, Aged, 80 and over, Antineoplastic Protocols, Breast Neoplasms (radiotherapy), Breast Neoplasms (surgery), Female, Humans, Incidence, Lymphedema (epidemiology), Mastectomy (adverse effects), Middle Aged, Proportional Hazards Models, Radiotherapy (adverse effects), Risk Factors, Sentinel Lymph Node Biopsy (adverse effects), Young Adult.
MESH :
- adverse effects : Mastectomy, Radiotherapy, Sentinel Lymph Node Biopsy.
- epidemiology : Lymphedema.
- radiotherapy : Breast Neoplasms.
- surgery : Breast Neoplasms.
- Adult, Aged, Aged, 80 and over, Antineoplastic Protocols, Female, Humans, Incidence, Middle Aged, Proportional Hazards Models, Risk Factors, Young Adult.

Abstract

Purpose

Axillary lymph node dissection (ALND) and radiation therapy (RT) are commonly recommended for mastectomy patients with positive sentinel lymph node biopsy (SLNB). Effective alternatives to ALND that reduce lymphedema risk are needed. We evaluated rates of lymphedema in mastectomy patients who received SLNB with RT, compared to ALND with or without RT.

Methods

627 breast cancer patients who underwent 664 mastectomies between 2005–2013 were prospectively screened for lymphedema, median 22.8 months follow-up (range 3.0–86.9). Each mastectomy was categorized as: SLNB-no RT, SLNB+RT, ALND-no RT, or ALND+RT. RT included chest wall +/− nodal radiation. Perometer arm volume measurements were obtained pre- and post-operatively. Lymphedema was defined as ≥10% arm volume increase. Kaplan-Meier and Cox regression analyses were performed to determine lymphedema rates and risk factors.

Results

Of 664 mastectomies, 52% (343/664) were SLNB-no RT, 5% (34/664) SLNB+RT, 9% (58/664) ALND-no RT, and 34% (229/664) ALND+RT. The two-year cumulative lymphedema incidence was 10.0% (95% CI: 2.6–34.4%) for SLNB+RT compared with 19.3% (95% CI: 10.8–33.1%) for ALND-no RT, and 30.1% (95% CI: 23.7–37.8%) for ALND+RT. The lowest cumulative incidence was 2.19% (95% CI: 0.88%–5.40%) for SLNB-no RT. By multivariate analysis, factors significantly associated with increased lymphedema risk included RT (p=0.0017), ALND (p=0.0001), greater number of lymph nodes removed (p=0.0006), no reconstruction (p=0.0418), higher BMI (p<0.0001) and older age (p=0.0021).

Conclusion

Avoiding completion ALND and instead receiving SLNB with RT may decrease lymphedema risk in patients requiring mastectomy. Future trials should investigate the safety of applying the ACOSOG Z0011 protocol to mastectomy patients.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011490

DOI: 10.1007/s10549-014-2856-3
PubMed: 24500108
PubMed Central: 4011490

Affiliations:

Le document en format XML

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<author><name sortKey="Miller, Cynthia L" sort="Miller, Cynthia L" uniqKey="Miller C" first="Cynthia L." last="Miller">Cynthia L. Miller</name>
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<author><name sortKey="Specht, Michelle C" sort="Specht, Michelle C" uniqKey="Specht M" first="Michelle C." last="Specht">Michelle C. Specht</name>
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<author><name sortKey="Skolny, Melissa N" sort="Skolny, Melissa N" uniqKey="Skolny M" first="Melissa N." last="Skolny">Melissa N. Skolny</name>
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<author><name sortKey="Smith, Barbara L" sort="Smith, Barbara L" uniqKey="Smith B" first="Barbara L." last="Smith">Barbara L. Smith</name>
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<author><name sortKey="Taghian, Alphonse G" sort="Taghian, Alphonse G" uniqKey="Taghian A" first="Alphonse G." last="Taghian">Alphonse G. Taghian</name>
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<series><title level="j">Breast cancer research and treatment</title>
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<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Antineoplastic Protocols</term>
<term>Breast Neoplasms (radiotherapy)</term>
<term>Breast Neoplasms (surgery)</term>
<term>Female</term>
<term>Humans</term>
<term>Incidence</term>
<term>Lymphedema (epidemiology)</term>
<term>Mastectomy (adverse effects)</term>
<term>Middle Aged</term>
<term>Proportional Hazards Models</term>
<term>Radiotherapy (adverse effects)</term>
<term>Risk Factors</term>
<term>Sentinel Lymph Node Biopsy (adverse effects)</term>
<term>Young Adult</term>
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<term>Adulte d'âge moyen</term>
<term>Biopsie de noeud lymphatique sentinelle (effets indésirables)</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Incidence</term>
<term>Jeune adulte</term>
<term>Lymphoedème (épidémiologie)</term>
<term>Mastectomie (effets indésirables)</term>
<term>Modèles de hasards proportionnels</term>
<term>Protocoles antinéoplasiques</term>
<term>Radiothérapie (effets indésirables)</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>
</keywords>
<keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Mastectomy</term>
<term>Radiotherapy</term>
<term>Sentinel Lymph Node Biopsy</term>
</keywords>
<keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Biopsie de noeud lymphatique sentinelle</term>
<term>Mastectomie</term>
<term>Radiothérapie</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><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>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Antineoplastic Protocols</term>
<term>Female</term>
<term>Humans</term>
<term>Incidence</term>
<term>Middle Aged</term>
<term>Proportional Hazards Models</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>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Incidence</term>
<term>Jeune adulte</term>
<term>Modèles de hasards proportionnels</term>
<term>Protocoles antinéoplasiques</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Purpose</title>
<p id="P1">Axillary lymph node dissection (ALND) and radiation therapy (RT) are commonly recommended for mastectomy patients with positive sentinel lymph node biopsy (SLNB). Effective alternatives to ALND that reduce lymphedema risk are needed. We evaluated rates of lymphedema in mastectomy patients who received SLNB with RT, compared to ALND with or without RT.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">627 breast cancer patients who underwent 664 mastectomies between 2005–2013 were prospectively screened for lymphedema, median 22.8 months follow-up (range 3.0–86.9). Each mastectomy was categorized as: SLNB-no RT, SLNB+RT, ALND-no RT, or ALND+RT. RT included chest wall +/− nodal radiation. Perometer arm volume measurements were obtained pre- and post-operatively. Lymphedema was defined as ≥10% arm volume increase. Kaplan-Meier and Cox regression analyses were performed to determine lymphedema rates and risk factors.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">Of 664 mastectomies, 52% (343/664) were SLNB-no RT, 5% (34/664) SLNB+RT, 9% (58/664) ALND-no RT, and 34% (229/664) ALND+RT. The two-year cumulative lymphedema incidence was 10.0% (95% CI: 2.6–34.4%) for SLNB+RT compared with 19.3% (95% CI: 10.8–33.1%) for ALND-no RT, and 30.1% (95% CI: 23.7–37.8%) for ALND+RT. The lowest cumulative incidence was 2.19% (95% CI: 0.88%–5.40%) for SLNB-no RT. By multivariate analysis, factors significantly associated with increased lymphedema risk included RT (p=0.0017), ALND (p=0.0001), greater number of lymph nodes removed (p=0.0006), no reconstruction (p=0.0418), higher BMI (p<0.0001) and older age (p=0.0021).</p>
</sec>
<sec id="S4"><title>Conclusion</title>
<p id="P4">Avoiding completion ALND and instead receiving SLNB with RT may decrease lymphedema risk in patients requiring mastectomy. Future trials should investigate the safety of applying the ACOSOG Z0011 protocol to mastectomy patients.</p>
</sec>
</div>
</front>
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<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="Miller, Cynthia L" sort="Miller, Cynthia L" uniqKey="Miller C" first="Cynthia L." last="Miller">Cynthia L. Miller</name>
<name sortKey="O Oole, Jean" sort="O Oole, Jean" uniqKey="O Oole J" first="Jean" last="O Oole">Jean 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="Smith, Barbara L" sort="Smith, Barbara L" uniqKey="Smith B" first="Barbara L." last="Smith">Barbara L. Smith</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>
</noCountry>
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Serveur d'exploration sur le lymphœdème

Risk of lymphedema after mastectomy – potential benefit of applying ACOSOG Z0011 protocol to mastectomy patients

Risk of lymphedema after mastectomy – potential benefit of applying ACOSOG Z0011 protocol to mastectomy patients

Source :

Descripteurs français

English descriptors

Abstract

Links toward previous steps (curation, corpus...)

Le document en format XML

Pour manipuler ce document sous Unix (Dilib)

Pour mettre un lien sur cette page dans le réseau Wicri

Pour générer des pages wiki

	Serveur d'exploration sur le lymphœdème
	Attention, ce site est en cours de développement ! Attention, site généré par des moyens informatiques à partir de corpus bruts. Les informations ne sont donc pas validées.