Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy

Introduction. The objective of this study was to compare the prevalence of late effects in the arm and shoulder in patients with breast cancer stage II who had radical modified mastectomy (RM) or breast-conserving therapy (BCT) followed by loco-regional adjuvant radiotherapy with or without chemotherapy/anti-oestrogen. Material and methods. All patients had axillary lymph node dissection. At a median of 47 months (range 32–87) post-surgery, 263 women (RM: n=186, BCT: n=77) were seen during an outpatient visit and had their arm and shoulder function and the presence of lymphedema assessed by a clinical examination, interview and self-rating. Volume calculation was used to measure lymphedema. Results. In the RM group 20% had developed arm lymphedema versus 8% in the BCT group (p=0.02). In multivariate analysis lymphedema was associated with a higher number of metastatic axillary lymph nodes [OR1.14, p=0.02], RM [OR 2.75, p=0.04] and increasing body mass index (BMI) [OR 1.11, p<0.01]. In the RM group 24% had a restricted range of motion in shoulder flexion compared to 7% in the BCT group (p<0.01). Shoulder pain was reported by 32% in the RM group and by 12% in the BCT group (p=0.001). Increasing observation time, RM, and increasing BMI were significantly associated with impaired arm/shoulder function. Discussion. Arm/shoulder problems including lymphedema were significantly more common after RM compared to BCT in irradiated breast cancer patients who have undergone axillary lymph node dissection. The performance of BCT should be encouraged when appropriate, to ensure a low prevalence of arm/shoulder morbidity including lymphedema.

[1]  N. Willich,et al.  Lymphödeme nach Mammakarzinom: Eine Studie über 5868 Fälle , 2008 .

[2]  A. Dupuy,et al.  Factors associated with increased breast cancer-related lymphedema volume , 2007, Acta oncologica.

[3]  Z. Nugent,et al.  Efficacy of complete decongestive therapy and manual lymphatic drainage on treatment-related lymphedema in breast cancer. , 2006, International journal of radiation oncology, biology, physics.

[4]  P. Goodwin,et al.  Medical, Psychosocial, and Health-Related Quality of Life Issues in Breast Cancer Survivors , 2007 .

[5]  J. Sitzia,et al.  Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study. , 2005, QJM : monthly journal of the Association of Physicians.

[6]  P. Christiansen,et al.  The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: A randomized study , 2005, Acta oncologica.

[7]  S. Steinberg,et al.  Comparison of pain, motion, and edema after modified radical mastectomy vs. local excision with axillary dissection and radiation , 1992, Breast Cancer Research and Treatment.

[8]  C. Laronga,et al.  Lymphedema of the Arm and Breast in Irradiated Breast Cancer Patients: Risks in an Era of Dramatically Changing Axillary Surgery , 2003, The breast journal.

[9]  A. Haid,et al.  Morbidity of Breast Cancer Patients Following Complete Axillary Dissection or Sentinel Node Biopsy Only: A Comparative Evaluation , 2002, Breast Cancer Research and Treatment.

[10]  R. Kreienberg,et al.  Long-Term Morbidity Following Axillary Dissection in Breast Cancer Patients – Clinical Assessment, Significance for Life Quality and the Impact of Demographic, Oncologic and Therapeutic Factors , 2000, Breast Cancer Research and Treatment.

[11]  A. Taghian,et al.  Risk of lymphedema after regional nodal irradiation with breast conservation therapy. , 2003, International journal of radiation oncology, biology, physics.

[12]  T. Worrell,et al.  Concurrent validity of upper-extremity volume estimates: comparison of calculated volume derived from girth measurements and water displacement volume. , 2003, Physical therapy.

[13]  T. Wobbes,et al.  Arm Morbidity after Complete Axillary Lymph Node Dissection for Breast Cancer , 2003, Acta chirurgica Belgica.

[14]  W. Kwan,et al.  Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  M. Ernst,et al.  Early and late morbidity associated with axillary levels I–III dissection in breast cancer , 2002, Journal of surgical oncology.

[16]  Mark W. Lipsey,et al.  Practical Meta-Analysis , 2000 .

[17]  J. Overgaard,et al.  Treatment Morbidity Associated with the Management of the Axilla in Breast-Conserving Therapy , 2000, Acta oncologica.

[18]  I. Tengrup,et al.  Arm Morbidity after Breast-conserving Therapy for Breast Cancer , 2000, Acta oncologica.

[19]  A. Meek.  Breast radiotherapy and lymphedema , 1998, Cancer.

[20]  M. Rezvani,et al.  Shoulder movement after the treatment of early stage breast cancer. , 1998, Clinical oncology (Royal College of Radiologists (Great Britain)).

[21]  E. Kalso,et al.  Pain and other symptoms during the first year after radical and conservative surgery for breast cancer. , 1996, British Journal of Cancer.

[22]  K. Kiel,et al.  Early-stage breast cancer: arm edema after wide excision and breast irradiation. , 1996, Radiology.

[23]  H. Thames,et al.  Fractionation sensitivity of a functional endpoint: impaired shoulder movement after post-mastectomy radiotherapy. , 1989, International journal of radiation oncology, biology, physics.