Radiation induced lymphedema in patients received hypofractionation schedules in adjuvant radiotherapy settings for non-metastatic breast cancer

Amr Ameen; Ahmed Badawy; Maher Soliman; Ashraf Elenbaby

Amr Ameen Alexandria university school of medicine
Ahmed Badawy Department of Clinical Oncology and Nuclear medicine, Faculty of medicine, Alexandria University
Maher Soliman Department of Clinical Oncology and Nuclear medicine, Faculty of medicine, Alexandria University
Ashraf Elenbaby Department of Clinical Oncology and Nuclear medicine, Faculty of medicine, Alexandria University

Keywords: Breast, Lymphedema, Hypofractionation

Abstract

Background

Hypofractionation was introduced in early breast cancer based on multiple clinical trials. The rationale behind hypofractionation is to deliver high dose per fraction over short duration without compromising the local control. The short fractionation was limited to early breast cancer with BCS. However, there are few data regarding the short course after mastectomy. In node positive disease, the role of hypofractionation schedules is limited due to afraid of late toxicity specially lymphedema. We conducted this study to assess the lymphedema in patient with high-risk early disease who received either moderate or ultra hypofractionation schedules.

Materials and methods

One hundred patients received adjuvant radiotherapy using moderate or ultra hypofractionation schedules with either pT1-3 or pN0-1 were subjected for pretreatment lymphedema assessment using International Society of Lymphology staging of lymphoedema and then after radiotherapy every 3 months for 4 years.

Aim of the work

The primary end point: To assess the radiation induced lymphedema incidence and to assess factors affecting lymphedema before and after radiotherapy.

Results

Patients with modified radical mastectomy were associated with high incidence of lymphedema with significant difference compared to BCS. Nighty seven percent of patients with lymphedema had axillary dissection with significant difference compared to sentinel Lymph node biopsy. After radiotherapy, the ratio of positive node to total node dissected was associated with high incidence of lymphedema.

In multivariate analysis. It was found that only axillary dissection was the most significant factor affecting lymphedema after 4 years with 4.9 odds ratio. Using either moderate hypofractionation or ultrahypofractionation had no effect on lymphedema incidence.

Conclusion

Axillary dissection is the most important risk factor for the development of lymphedema specially after radiotherapy. A higher dose per fraction did not increase the incidence of lymphedema even in patients with high-risk node positive early breast cancer.