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Lymphedema following irradiation in breast cancer: A cross-sectional study.

e11569 Background: Nearly 15-30% of breast cancer patients (pts) face lymphedema (LE) following locoregional therapy, incidence being higher with surgery (Sx) & radiotherapy (RT) combination than with Sx alone. We intended to study the incidence of post-RT LE and associated symptoms.


METHOD
We evaluated 104 unilateral breast cancer pts who had completed curative therapy (Sx + RT + chemotherapy ± hormone therapy HT), with a minimum follow up of 6 months. Besides demographic & treatment details, symptoms associated with LE and objective measurements of upper limb circumference were recorded using an indigenous questionnaire.


RESULTS
Median age was 45 years (range 28-65). Chest wall or breast RT was delivered using medial & lateral tangential portals (Cobalt-60 unit) in 88 pts & with 12 MeV electrons in 18 pts. Of all pts, 77 were given supraclavicular & axillary RT. HT was given to 72 pts. Pathological stages were: T1/2- 73, T3/4- 27, Tx-4; N0-44, N1-25, N2/3-33, Nx-2. Arm swelling was reported by 68 pts (mild-40, moderate-28). Other symptoms included reduced range of motion (mild-52, moderate-24), fatigue (48), pain (28), numbness (20), infections (12), shoulder droop (12) and local tenderness (8). Forty-four pts reported having psychological stress (mild-40, moderate-4). Nearly 60% had symptoms mandating change in physical activity (mild-56, moderate-8). Dominant hand was involved in 57 pts. Shoulder exercises were advised in 84 pts; compliance was poor in 16, average in 32, & good in 36. Only 36 pts were advised compression garments, compliance being poor in 28, average in 4 & good in 4. Objective measurements revealed a difference of ≥3 cm in 27 pts in mid-arm circumference (MAC) (median 5.5 cm, maximum 8 cm) & 34 pts in forearm circumference (FAC) (median 3.5, maximum 7 cm). There was no significant association between MAC or FAC with age, stage, body surface area, basal metabolic index, Sx type, chemotherapy or HT. Perceived LE and objective measurements correlated well. MAC difference >3 cm was seen in 28.5% (22/77) pts who received axillary RT and in 18.5% (5/27) of those who received only local RT.


CONCLUSIONS
LE, with its associated complications, is often understudied in breast cancer survivors. Revision of Sx and RT policies (e.g., omission of axillary dissection & RT in selected pts) may help minimise LE. No significant financial relationships to disclose.