MedicalToday

Axillary Treatment and Chronic Breast Cancer–Related Lymphedema: Implications for Prospective Surveillance and Intervention

– An ASCO Reading Room selection


This Reading Room is a collaboration between ® and:


Medical Today
Below is the abstract of the article. or on the link below.

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:

ASCO Publications Corner

ASCO Publications Corner