title: Risk of lymphedema after regional nodal irradiation with breast conservation therapy.
abstract: OBJECTIVE
  To evaluate the risk factors for lymphedema in patients receiving breast conservation therapy for early-stage breast cancer.
  
  
  METHODS
  Between 1982 and 1995, 727 Stage I-II breast cancer patients were treated with breast conservation therapy at Massachusetts General Hospital. A retrospective analysis of the development of persistent arm edema was performed. Lymphedema was defined as a >2-cm difference in forearm circumference compared with the untreated side. The median follow-up was 72 months. Breast and regional nodal irradiation (BRNI) was administered in 32% of the cases and breast irradiation alone in 68%.
  
  
  RESULTS
  Persistent arm lymphedema was documented in 21 patients. The 10-year actuarial incidence was 4.1%. The median time to edema was 39 months. The only significant risk factor for lymphedema was BRNI. The 10-year risk was 1.8% for breast irradiation alone vs. 8.9% for BRNI (p = 0.001). The extent of axillary dissection did not predict for lymphedema even within the subgroups of patients defined by the extent of irradiation. Most patients underwent Level I or II dissection. In this subgroup, the lymphedema risk at 10 years was 10.7% for BRNI vs. 1.0% for breast irradiation alone (p = 0.0003).
  
  
  CONCLUSIONS
  Nodal irradiation was the only significant risk factor for arm lymphedema in patients receiving breast conservation therapy for early-stage breast cancer. Our data suggest that this risk is low with Level I/II dissection and breast irradiation. However, even after the addition of radiotherapy to the axilla and supraclavicular fossa, the development of lymphedema was only 1 in 10, lower than generally recognized.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. snpowell@partners.org
authors.forename: John J
authors.initials: JJ
authors.lastname: Coen
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kachnic
authors.forename: Sherif I
authors.initials: SI
authors.lastname: Assaad
authors.forename: Simon N
authors.initials: SN
authors.lastname: Powell
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001365:Axilla; D001900:Boston / Q000453:epidemiology; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D019583:Dose Fractionation, Radiation; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D015993:Life Tables; D008197:Lymph Node Excision / Q000009:adverse effects; D015182:Lymphatic Irradiation / Q000009:adverse effects*; D008209:Lymphedema / Q000453:epidemiology / Q000209:etiology*; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D020360:Neoadjuvant Therapy; D009378:Neoplasms, Multiple Primary / Q000150:complications / Q000532:radiotherapy / Q000601:surgery; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D011882:Radiotherapy, High-Energy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013629:Tamoxifen / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D013629:Tamoxifen; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil