Breast Cancer–Related Lymphedema: Risk Factors, Screening, Management, and the Impact of Locoregional Treatment

McLaughlin, Sarah A.; Brunelle, Cheryl L.; Taghian, Alphonse G.

doi:10.1200/jco.19.02896

Cited by 79 publications

(99 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Skin toxicities acutely manifest as erythema, desquamation, and alopecia or skin atrophy, while fibrosis and ulcer formation develop as late effects (7). Other late effects of RT include osteoradionecrosis, fracture, impaired wound healing and muscle atrophy, as well as lymphedema (8)(9)(10). Importantly, sarcoma is the archetypal mesenchymal cancer in which high dose RT is often used despite the high risk of toxicity.…”

Section: Introductionmentioning

confidence: 99%

FLASH Proton Radiotherapy Spares Normal Epithelial and Mesenchymal Tissues While Preserving Sarcoma Response

et al. 2021

View full text Add to dashboard Cite

In studies of electron and proton radiotherapy, ultrahigh dose rates of FLASH radiation therapy appear to produce fewer toxicities than standard dose rates while maintaining local tumor control. FLASH-proton radiotherapy (F-PRT) brings the spatial advantages of PRT to FLASH dose rates (>40 Gy/sec), making it important to understand if and how F-PRT spares normal tissues while providing anti-tumor efficacy that is equivalent to standard-proton radiotherapy (S-PRT). Here we studied PRT damage to skin and mesenchymal tissues of muscle and bone and found that F-PRT of the C57BL/6 murine hind leg produced fewer severe toxicities leading to death or requiring euthanasia than S-PRT of the same dose. RNAseq analyses of murine skin and bone revealed pathways upregulated by S-PRT yet unaltered by F-PRT, such as apoptosis signaling and keratinocyte differentiation in skin, as well as osteoclast differentiation and chondrocyte development in bone. Corroborating these findings, F-PRT reduced skin injury, stem cell depletion, and inflammation, mitigated late effects including lymphedema, and decreased histopathologically detected myofiber atrophy, bone resorption, hair follicle atrophy, and epidermal hyperplasia. F-PRT was equipotent to S-PRT in control of two murine sarcoma models, including at an orthotopic intramuscular site, thereby establishing its relevance to mesenchymal cancers. Finally, S-PRT produced greater increases in TGF-β1 in murine skin and the skin of canines enrolled in a phase 1 study of F-PRT versus S-PRT. Collectively, these data provide novel insights into F-PRT-mediated tissue sparing and support its ongoing investigation in applications that would benefit from this sparing of skin and mesenchymal tissues. SignificanceThese findings will spur investigation of FLASH radiotherapy in sarcoma and additional cancers where mesenchymal tissues are at risk, including head and neck cancer, breast cancer, and pelvic malignancies.Research.

show abstract

Section: Introductionmentioning

confidence: 99%

FLASH Proton Radiotherapy Spares Normal Epithelial and Mesenchymal Tissues While Preserving Sarcoma Response

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In contrast, when evaluating associations between lymphedema and infection, Fu 26 stated that women presenting upper limb infection are more likely to develop lymphedema, and Ferguson et al 20 noted that infection increases risks for developing lymphedema. Other assessments have also reported significant associations between infection in the limb ipsilateral to surgery and lymphedema 12,31,35,36 .…”

Section: Variablesmentioning

confidence: 95%

“…Statistical significances were observed only between this type of care and for patients undergoing chemotherapy. Studies have observed that both radiotherapy and chemotherapy present risks concerning lymphedema development 10,22,[29][30][31] . In a Brazilian cohort followed at the same hospital unit, advanced breast cancer stage, lymphatic drainage chain radiotherapy, and chemotherapy administration in the upper limb ipsilateral to surgery increase the risk for limb lymphedema 13 .…”

Section: Variablesmentioning

confidence: 99%

Guidelines for the prevention of secondary lymphedema following breast cancer treatment: adhesion and associated factors

et al. 2021

View full text Add to dashboard Cite

Introduction: Lymphedema is the most feared complication that may take place after breast cancer treatment. With treatment progression, doubts have arisen regarding the real benefits of lymphedema prevention care, as well as of patient adherence to guidelines. Objective: In this context, the aim of this study was to assess patient adherence to preventive lymphedema guidelines and the distribution of sociodemographic, clinical, and treatment variables according to adherence to treatment. Methods: A cross-sectional study conducted at the Cancer Hospital III/INCA, Rio de Janeiro, Brazil, concerning patients with breast cancer undergoing surgical treatment with an axillary approach. Participants were questioned about assistance care performance, exercise-related care, and limb ipsilateral to surgery care. A descriptive analysis of patient demographic, clinical, treatments, postoperative complications variables, and main outcomes (adherence to the guidelines) was performed through a central tendency measure and data dispersion and frequency measures analyses. Differences between means were assessed using the Student’s t-test, while differences between proportions were evaluated using the chi-square test. A significance level of 5% was considered for all assessments. Results: Of the 103 women included in this study, 89.3% adhered to assistance care, 61.2% adhered to limb care, and 42.7% performed exercise-related care. Women undergoing chemotherapy (p = 0.030) and axillary lymphadenectomy (AL) (p = 0.017) exhibited greater adherence to care. Non-white patients (p = 0.048) and those who underwent AL (p = 0.025) adhered to limb care more frequently. Finally, patients displaying lower education levels (p = 0.013) and those who underwent AL (p = 0.009) adhered more frequently to limb exercises. Conclusion: Patients adhered the most to assistance care and limb care compared to exercise practice. Patients undergoing chemotherapy displayed greater adherence to care and non-white patients adhered the most to limb care. Women who underwent AL displayed greater adherence to all types of care and those presenting lower education levels adhered more frequently to exercise guidelines.

show abstract

“…Treatment: Initial treatment is conservative consisting of complete decongestive therapy (CDT). CDT consists of a reduction phase and a maintenance phase consisting of components including compression wrapping, compression garments, skin care, exercise, education and manual lymphatic drainage [148]. Pneumatic compression devices may be used in conjunction with CDT and may provide a synergistic effect when combined with manual lymphatic drainage [147].…”

Section: Lymphedemamentioning

confidence: 99%

A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment

Chang

Asher

Smith

2021

Cancers

View full text Add to dashboard Cite

Persistent pain following treatment for breast cancer is common and often imprecisely labeled as post-mastectomy pain syndrome (PMPS). PMPS is a disorder with multiple potential underlying causes including intercostobrachial nerve injury, intercostal neuromas, phantom breast pain, and pectoralis minor syndrome. Adding further complexity to the issue are various musculoskeletal pain syndromes including cervical radiculopathy, shoulder impingement syndrome, frozen shoulder, and myofascial pain that may occur concurrently and at times overlap with PMPS. These overlapping pain syndromes may be difficult to separate from one another, but precise diagnosis is essential, as treatment for each pain generator may be distinct. The purpose of this review is to clearly outline different pain sources based on anatomic location that commonly occur following treatment for breast cancer, and to provide tailored and evidence-based recommendations for the evaluation and treatment of each disorder.

show abstract

Breast Cancer–Related Lymphedema: Risk Factors, Screening, Management, and the Impact of Locoregional Treatment

Abstract: Author affiliations and support information (if applicable) appear at the end of this article.

Cited by 79 publications

References 63 publications

FLASH Proton Radiotherapy Spares Normal Epithelial and Mesenchymal Tissues While Preserving Sarcoma Response

FLASH Proton Radiotherapy Spares Normal Epithelial and Mesenchymal Tissues While Preserving Sarcoma Response

Guidelines for the prevention of secondary lymphedema following breast cancer treatment: adhesion and associated factors

A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment

Contact Info

Product

Resources

About