Changes in volume and incidence of lymphedema during and after treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC) in patients with breast cancer

Abstract

PurposesThe purposes of this study were to investigate the incidence of lymphedema in patients with breast cancer during and after adjuvant treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC), to identify predictors for development of lymphedema, and to describe consequences in daily life in relation to lymphedema.MethodsThis is a prospective study with measurements before chemotherapy (T0), during chemotherapy before cycle 2 (T1), cycle 4 (T2), and 1 month after completion of treatment (T3). Volume change was monitored using tape measurements. Lymphedema was defined as ≥ 10% volume difference. Linear mixed-effect models were estimated to analyze differences in arm volume and consequences in daily life (total score and domain scores of the Lymph-International Classification of Functioning (ICF) questionnaire) over time and to identify treatment and patient characteristics as predictors for changes in volume.ResultsForty-eight patients completed all measurements. Volume did not change during TAC treatment. One month after treatment, volume was significantly increased compared to T0-T2, and 12 patients (25%) had developed lymphedema. Axillary lymph node dissection was associated with lymphedema (ES 2.9, 95% CI 0.02–5.7; p < 0.05). In patients with and without lymphedema, 1 month after completion (T3), the Lymph-ICF questionnaire showed significant limitations in physical function compared to T0-T2. In patients with lymphedema at T3, a significant association between volume and total score on the Lymph-ICF questionnaire on physical function and mobility activities was observed.ConclusionsOne month after treatment in 12 patients (25%), volume difference increased over 10%. Axillary lymph node dissection was predictive for development of lymphedema. All patients, but more patients with lymphedema, perceived difficulties in activities in daily life after treatment.

The Development and Treatment of Lymphatic Dysfunction in Cancer Patients and Survivors

“…Such lymphatic dysfunction can occur prior to treatments of surgical dissection and/or RT, suggesting that cancer progression, particularly LN metastasis, contributes to lymphatic dysfunction in cancer patients prior to surgery and RT. While there is evidence that chemotherapy may potentially contribute to the development of cancer-acquired LE [66][67][68][69], further longitudinal studies are needed to understand all the contributing factors that can cause lymphatic dysfunction. Nonetheless, recent results in Figure 7 confirm the results of other studies showing subclinical edema measured with bioimpedance of water content in the arms in breast cancer patients prior to first-line treatment [70,71].…”

Assessment of Potential Risk Factors and Skin Ultrasound Presentation Associated with Breast Cancer-Related Lymphedema in Long-Term Breast Cancer Survivors

“…To date, ALND [7,9], regional radiotherapy [14,15], removal of more axillary lymph nodes [10,16], and higher body mass index (BMI) [17,18] are well-defined risk factors for developing BCRL. Other possible risk factors related to BCRL such as hypertension, chemotherapy, age, and genetic predisposition have yet to be investigated, or they have given inconsistent results in different studies [8,19,20].…”

Abordagem Fisioterapêutica de uma Paciente com Linfedema de Membro Superior Prévio à cirurgia para Câncer de Mama: Relato de caso

“…Outra possível causa para o linfedema prévio à cirurgia se deve ao uso de alguns quimioterápicos. Hidding et al 15 avaliaram a incidência de linfedema antes, durante e após a quimioterapia adjuvante com docetaxel, doxorrubicina e ciclofosfamida. Observaram que não ocorreu mudança no volume do membro durante o tratamento, mas houve mudança no volume um mês após o término da quimioterapia em 25% das pacientes.…”