Lymphedema Risk is Greatly Increased With.........

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Lymphedema Risk is Greatly Increased with Boost of Radiation to Axillary Nodes

http://www.hopkinsbreastcenter.org/artemis/200612/7.html

The significant risk of developing lymphedema may outweigh the benefit of

receiving an extra boost of radiation to lymph nodes possibly involved in

early-stage breast cancer. That is the conclusion of a study presented at the

Annual Meeting of the American Society for Therapeutic Radiology and Oncology in

Philadelphia.

Lymphedema is an uncomfortable swelling of a limb caused by a build-up of

lymphatic fluid. This occurs when the lymph vessels are damaged and/or nodes are

removed. The disruption of lymphatic flow prevents the proper drainage, causing

a back-up of fluid. About 15-20% of women with breast cancer who have lymph

nodes removed during surgery will develop lymphedema.

" We know radiation can increase one's risk of developing lymphedema, so it's

important to determine whether the radiation technique or dose contributes, "

explained B. , M.D., a resident in the radiation oncology department

at Fox Chase Cancer Center and lead author of the new study.

Standard therapy for women with early-stage breast cancer calls for radiation

following a lumpectomy. The radiation field includes the whole affected breast

and some of the lymph nodes under the arm, called the axillary lymph nodes.

Doctors may also irradiate the lymph nodes found in the upper axilla and above

the clavicle, depending on the number of nodes removed and the number that test

positive for cancerous cells. Sometimes, an additional dose or " boost " of

radiation is added to the axillary region.

" The reason we irradiate the lymph node regions is to prevent recurrence of

disease in those locations, " said. " When an aggressive lymph-node

dissection is performed, the utility of additional radiation is questionable.

This is the subject of some debate. "

' study consisted of 2,581 women with early-stage breast cancer treated at

Fox Chase Cancer Center with lumpectomy, axillary-node dissection and radiation

between 1970 and 2005. A total of 2,174 patients (84%) were treated with

radiation to the breast alone, 221patients (8.6%) were treated to the breast and

supraclavicular lymph nodes while 184 patients (7.1%) received an additional

boost of radiation to the axillary nodes. The median follow-up was 81 months.

" The most striking result we found involved women who had more than four

positive lymph nodes, " explained . " They were four times more likely to

develop lymphedema when treated with a boost, despite similar risks of nodal

recurrences.

" Given the increased risk of lymphedema and the lack of evidence supporting

improvements in nodal recurrences from the boost, we should carefully consider

these results before delivering a boost to our patients, " concluded.

SOURCES:

48th Annual Meeting of the American Society for Therapeutic Radiology and

Oncology, November 8, 2006, Philadelphia, PA

Fox Chase Cancer Center (http://www.fccc.edu)

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