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. 2014 Mar 1;88(3):565-71.
doi: 10.1016/j.ijrobp.2013.11.232. Epub 2014 Jan 7.

The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: a prospective cohort study

Laura E G Warren  1 , Cynthia L Miller  1 , Nora Horick  2 , Melissa N Skolny  1 , Lauren S Jammallo  1 , Betro T Sadek  1 , Mina N Shenouda  1 , Jean A O'Toole  3 , Shannon M MacDonald  1 , Michelle C Specht  4 , Alphonse G Taghian  5
Affiliations

The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: a prospective cohort study

Laura E G Warren et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose/objective: Lymphedema after breast cancer treatment can be an irreversible condition with a negative impact on quality of life. The goal of this study was to identify radiation therapy-related risk factors for lymphedema.

Methods and materials: From 2005 to 2012, we prospectively performed arm volume measurements on 1476 breast cancer patients at our institution using a Perometer. Treating each breast individually, 1099 of 1501 patients (73%) received radiation therapy. Arm measurements were performed preoperatively and postoperatively. Lymphedema was defined as ≥10% arm volume increase occurring >3 months postoperatively. Univariate and multivariate Cox proportional hazard models were used to evaluate risk factors for lymphedema.

Results: At a median follow-up time of 25.4 months (range, 3.4-82.6 months), the 2-year cumulative incidence of lymphedema was 6.8%. Cumulative incidence by radiation therapy type was as follows: 3.0% no radiation therapy, 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 regional lymph node radiation (RLNR) (SC ± PAB) was 1.7 (P=.025) compared with breast/chest wall radiation alone. There was no difference in lymphedema risk between SC and SC + PAB (P=.96). Other independent risk factors included early postoperative swelling (P<.0001), higher body mass index (P<.0001), greater number of lymph nodes dissected (P=.018), and axillary lymph node dissection (P=.0001).

Conclusions: In a large cohort of breast cancer patients prospectively screened for lymphedema, RLNR significantly increased the risk of lymphedema compared with breast/chest wall radiation alone. When considering use of RLNR, clinicians should weigh the potential benefit of RLNR for control of disease against the increased risk of lymphedema.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Cumulative incidence of lymphedema stratified by type of radiotherapy.
See this image and copyright information in PMC

Comment in

  • Radiotherapy: avoiding lymphedema.
    Villanueva T. Villanueva T. Nat Rev Clin Oncol. 2014 Mar;11(3):121. doi: 10.1038/nrclinonc.2014.8. Epub 2014 Jan 28. Nat Rev Clin Oncol. 2014. PMID: 24469743 No abstract available.

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