Cancer Res Treat.  2015 Jul;47(3):416-423. 10.4143/crt.2014.079.

Breast Cancer-Related Lymphedema after Neoadjuvant Chemotherapy

• Kim M
• Park IH
• Lee KS
• Ro J
• Jung SY
• Lee S
• Kang HS
• Lee ES
• Kim TH
• Cho KH
• Shin KH

• KMID: 2148490
• DOI: http://doi.org/10.4143/crt.2014.079

Abstract

PURPOSE
The risk for lymphedema (LE) after neoadjuvant chemotherapy (NCT) in breast cancer patients has not been fully understood thus far. This study is conducted to investigate the incidence and time course of LE after NCT.
MATERIALS AND METHODS
A total of 313 patients with clinically node-positive breast cancer who underwent NCT followed by surgery with axillary lymph node (ALN) dissection from 2004 to 2009 were retrospectively analyzed. All patients received breast and supraclavicular radiation therapy (SCRT). The determination of LE was based on both objective and subjective methods, as part of a prospective database.
RESULTS
At a median follow-up of 5.6 years, 132 patients had developed LE: 88 (28%) were grade 1; 42 (13%) were grade 2; and two (1%) were grade 3. The overall 5-year cumulative incidence of LE was 42%. LE first occurred within 6 months after surgery in 62%; 1 year in 77%; 2 years in 91%; and 3 years in 96%. In a multivariate analysis, age (hazard ratio [HR], 1.66; p < 0.01) and the number of dissected ALNs (HR, 1.68; p < 0.01) were independent risk factors for LE. Patients with both of these risk factors showed a significantly higher 5-year cumulative incidence of LE compared with patients with no or one risk factor (61% and 37%, respectively; p < 0.001). The addition of adjuvant chemotherapy did not significantly correlate with LE.
CONCLUSION
LE after NCT, surgery, and SCRT developed early after treatment, and with a high incidence rate. More frequent surveillance of arm swelling may be necessary in patients after NCT, especially during the first few years of follow-up.

Keyword

Breast neoplasms; Lymphedema; Neoadjuvant chemotherapy; Risk factors

MeSH Terms

Arm
Breast Neoplasms
Breast*
Chemotherapy, Adjuvant
Drug Therapy*
Follow-Up Studies
Humans
Incidence
Lymph Nodes
Lymphedema*
Multivariate Analysis
Prospective Studies
Retrospective Studies
Risk Factors

Figure

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  Fig. 1. Kaplan-Meier plots of the cumulative incidence of breast cancer–related lymphedema.

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  Fig. 2. Kaplan-Meier plots of the cumulative rates of breast cancer–related lymphedema in accordance to the number of risk factors (age ≥ 50 years and > 10 dissected axillary nodes).

Reference

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