Axillary Treatment and Chronic Breast Cancer–Related Lymphedema: Implications for Prospective Surveillance and Intervention
– An ASCO Reading Room selection
February 6, 2024This Reading Room is a collaboration between ® and:
Purpose
The PREVENT randomized trial assessed progression to chronic breast cancer–related lymphedema (cBCRL) after intervention triggered by bioimpedance spectroscopy (BIS) or tape measurement (TM). This secondary analysis identifies cBCRL risk factors on the basis of axillary treatment.
Methods
Between June 2014 and September 2018, a total of 881 patients received sentinel node biopsy (SNB; n = 651), SNB + regional node irradiation (RNI; n = 58), axillary lymph node dissection (ALND; n = 85), or ALND + RNI (n = 87). The primary outcome was the 3-year cBCRL rate requiring complex decongestive physiotherapy (CDP).
Results
After a median follow-up of 32.8 months (IQR 21-34.3), 69 of 881 patients (7.8%) developed cBCRL. For TM, 43 of 438 (9.8%) developed cBCRL versus 26 of 443 (5.9%) for BIS (P=0.028). The 3-year actuarial risk of cBCRL was 4.4% (95% CI 2.7-6.1), 4.2% (95% CI 0-9.8), 25.8% (95% CI 15.8-35.8), and 26% (95% CI 15.3-36.7). Rural residence increased the risk in all groups. For SNB, neither RNI (SNB 4.1% vs SNB + RNI 3.4%) nor taxane (4.4%) increased cBCRL, but risk was higher for patients with a BMI of ≥30 (6.3%). For SNB + RNI, taxane use (5.7%) or supraclavicular fossa (SCF) radiation (5.0%) increased cBCRL. For ALND patients, BMI ≥25 or chemotherapy increased cBCRL. For ALND + RNI, most patients received SCF radiation and taxanes, so no additional risk factors emerged.
Conclusion
The extent of axillary treatment is a significant risk factor for cBCRL. Increasing BMI, rurality, SCF radiation, and taxane chemotherapy also increase risk. These results have implications for a proposed risk-based lymphedema screening, early intervention, and treatment program.
Read an interview about the study here.
Read the full article
Axillary Treatment and Chronic Breast Cancer–Related Lymphedema: Implications for Prospective Surveillance and Intervention
Primary Source
JCO Oncology Practice
Source Reference: