Hipoestesia, dor e incapacidade no membro superior após radioterapia adjuvante no tratamento para câncer de mama

Abstract

BACKGROUND AND OBJECTIVES: Surgery and radiotherapy (RT) may induce upper limb (UP) pain, functional disorder and daily life activities impairment. This study aimed at evaluating and comparing superficial sensitivity (SS) on the dermatome corresponding to the intercostobrachial sensory nerve (ICBN), pain and disability of UL ipsilateral to surgery before and after adjuvant RT. METHOD: Twenty females submitted to surgery including axillary lymphadenectomy (AL) were evaluated before and immediately after adjuvant RT (25-30 sessions). The following tools were used to evaluate SS, pain and disability: esthesiometry, McGill Pain Questionnaire (MPQ), Pain Rating Index and shoulder disability (SPADI). Two measures were obtained from MPQ: number of words chosen (NWC) and pain rating index (PRI). Wilcoxon Signed Rank Test for paired samples was used for intragroup comparison, considering significant p < 0.05. RESULTS: There has been significant SS decrease after RT by increased esthesiometer pressure from 1.9 ± 0.2 to 2.8 ± 0.2 (p = 0.004) indicating hypoesthesia. There has been no difference in contralateral UL. NWC and PRI scores have significantly increased (p = 0.005 and p = 0.006) after RT. There has been significant total SPADI score increase after RT (p = 0.0001), with increased disability from 24.6 ± 5.7 to 39.2 ± 5.7 (p = 0.001) and pain from 26.3 ± 6.4 to 48.4 ± 7.1 (p = 0.001). CONCLUSION: Hypoesthesia was identified in the ICBN pathway, in addition to UL pain and disability after adjuvant RT.

Late locoregional complications associated with adjuvant radiotherapy in the treatment of breast cancer: Systematic review and meta‐analysis

“…For example, partial mastectomy followed by radiotherapy offers similar locoregional control to mastectomy; and sentinel lymphadenectomy can safely replace axillary dissection for low volume axillary disease . Even given these advances, the locoregional treatment is associated with late complications as lymphedema, capsular contracture, limitation in shoulder mobility, pain, breast and pulmonary fibrosis, brachial plexopathy, sensibility modifications and cardiac toxicity . This systematic review with meta‐analysis attempts to provide a structured analysis of the large number and variability of reports in the literature regarding late locoregional complications after radiotherapy.…”

Upper Limb Functionality and Quality of Life in Women with Five-Year Survival after Breast Cancer Surgery

“…Some studies mention pain as the most incident comorbidity directly related to the worsening of upper extremity function and/or a worse quality of life. 5,16,33,34 The onset of pain may occur immediately after surgery, or it may occur as a consequence of radiation, 5 and the pain can endure for a long period of time. The intercostobrachial nerve lesion is considered the main cause of pain, 33 and some other causes may be myofascial pain syndrome and axillary cord.…”

“…4 The primary treatment choice for BC is surgery (radical or conservative), and the other options are radiation, chemotherapy, hormonal therapy and targeted therapy as adjuvant treatments. 5 Despite the advances in surgical techniques, the procedure is still associated with a high prevalence of complications on the ipsilateral upper limb, and more than half of the patients who undergo axillary clearance present post-surgery comorbidities. 6 The main complications related to surgery are sensitivity impairment, seroma production, altered ventilatory capacity, lymphedema, axillary cording, reduced strength on the upper limb, reduced range of motion (ROM) of the arm and shoulder, and pain.…”

Reconstrução mamária imediata versus não reconstrução pós-mastectomia: estudo sobre qualidade de vida, dor e funcionalidade

“…For this last one, the average pain intensity was considered moderate 22 in both groups. This fact does not allow us to indicate a cause and effect relationship, because this is a cross-sectional study 24 and variables related to the surgery, such as nerve damage, were not controlled 25 .…”