Arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage I. Results from a randomised trial. Uppsala-Orebro Breast Cancer Study Group

Abstract

The incidence and time course of arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy to the breast was assessed in a prospective randomised trial among 381 patients with stage I breast cancer. At 3-12 months, arm symptoms were reported by 59/110 of the patients who had > or = 10 lymph nodes found in the axillary specimen versus 85/253 in whom < 10 lymph nodes were found (P = 0.002); at 13-36 months, the corresponding figures were 35/106 versus 44/225 (P = 0.001). Postoperative wound complications increased the incidence of arm symptoms at 3-12 months from 104/283 to 39/79 at 3-12 months (P = 0.03). Employed patients and patients < 65 years of age reported arm symptoms at 3-12 months in 86/161 and 94/191 compared to 58/207 and 50/177 among retired patients and patients > or = 65 years of age, respectively (P = 0.0001 and P = 0.0002, respectively). In a multivariate logistic regression analysis at 3-12 months, only young age (relative risk = 0.93 per year of increasing age, 95% CI 0.91-0.97) and the number of lymph nodes found in the axillary specimen (relative risk = 1.11 per lymph node found, 95% CI 1.05-1.18) remained statistically significant. No negative impact on arm morbidity was found by the addition of postoperative radiotherapy only to the breast, either in univariate or multivariate models. We conclude that factors directly related to the extent of the surgical procedure and young age are determinants of arm morbidity after breast preserving treatment for stage I breast cancer. Arm symptoms are most common during the first year after treatment and are reduced over the subsequent 2-3 years by around 40-50%.