title: Supraclavicular radiotherapy must be limited laterally by the coracoid to avoid significant adjuvant breast nodal radiotherapy lymphoedema risk.
abstract: This cross-sectional study aimed to investigate the effect of supraclavicular fossa (SCF) radiotherapy volumes as well as patient characteristics and nodal pathology on the development of lymphoedema. Ninety-one women who had received SCF nodal radiotherapy after axillary dissection were evaluated. Lymphoedema was defined by two measurements: limb volume difference 200 mL, or circumference difference 10 cm proximal or distal to the olecranon>2 cm. On univariate analysis, the addition of axillary to SCF radiotherapy, increasing width of the SCF field, increasing age, presence of extracapsular extension of nodal involvement and use of hormone treatment was associated with lymphoedema by either one or both definitions. For both definitions of lymphoedema, on multivariate analysis, increasing nodal radiotherapy volume remained significant (P=0.02 to 0.007), as did increased age (P=0.05 to 0.001). We conclude that conventionally fractionated SCF radiotherapy limited laterally by the coracoid process has a lymphoedema risk similar to that expected from axillary dissection alone and a lower risk than wider SCF fields with or without an axillary boost.
authors.affiliation: Cancer Care Centre, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia. grahamp@sesahs.nsw.gov.au
authors.forename: P
authors.initials: P
authors.lastname: Graham
authors.forename: R
authors.initials: R
authors.lastname: Jagavkar
authors.forename: L
authors.initials: L
authors.lastname: Browne
authors.forename: E
authors.initials: E
authors.lastname: Millar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001365:Axilla; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D008209:Lymphedema / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome