J Breast Cancer.  2023 Dec;26(6):544-557. 10.4048/jbc.2023.26.e43.

Incidence of and Influencing Factors for Arm Lymphedema After Salvage Treatment for an Isolated Locoregional Recurrence of Breast Cancer

• Kim N
• Kim H
• Hwang JH
• Lee JE
• Park W
• Cho WK
• Nam SJ
• Kim SW
• Yu J
• Chae BJ
• Lee SK
• Ryu JM
• Im YH
• Ahn JS
• Park YH
• Kim JY
• Kim TG

• KMID: 2550422
• DOI: http://doi.org/10.4048/jbc.2023.26.e43

Abstract

Purpose
Data on subsequent arm lymphedema (SAL) after salvage treatment for locoregional recurrence (LRR) of breast cancer are limited. We conducted a study to evaluate the risk of SAL in patients with LRR.
Methods
We reviewed the data of patients with breast cancer who had LRR and were initially diagnosed between January 2003 and December 2017. Among the 214 patients who received curative salvage treatment, most had local (n = 125, 57.9%), followed by regional (n = 73, 34.1%), and locoregional (n = 16, 7.9%) recurrences. A competing risk analysis considering the factors of death and a second LRR were performed to exclude potential malignant lymphedema. We used the Fine-Gray subdistribution hazards model to estimate the hazard ratio (HR) for comparing the risk of SAL.
Results
With a median follow-up duration of 41.4 months (interquartile range, 25.6–65.1), 51 patients (23.8%) experienced SAL with a median interval of 9.9 months after treatment. The two-year cumulative incidence of SAL was 12.7%. Among the 18 patients with initial lymphedema, nine (50.0%) developed SAL. Multivariate analysis revealed that a history of lymphedema (HR, 4.61; p < 0.001) and taxane-based salvage chemotherapy (HR, 2.38; p = 0.009) were significantly associated with SAL development.
Conclusion
Salvage treatment for LRR-induced SAL was performed in 24% of the patients. A history of initial lymphedema and salvage taxane-based chemotherapy increases the risk of developing SAL. Therefore, close surveillance for the incidence of SAL is required in patients opting for salvage treatment for LRR.

Keyword

Breast Neoplasms; Lymphedema; Neoplasm Recurrence, Local; Radiotherapy