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

“…ARM is a minimally invasive technique that can be readily added to SLNB and/or ALND and can significantly reduce the incidence of BCRL, which reportedly varies according to measurement technique, length of follow-up, time to measurement, use of whole breast radiation, and extent of surgery [ 36 ]. Complications that are frequently associated with BCRL include restricted ipsilateral shoulder mobility in approximately 16.7% of women treated for breast cancer [ 37 ]. Breast cancer survivors with lymphedema might also experience different degrees of physical and emotional disability that could affect the quality of their everyday lives [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical application of axillary reverse mapping in patients with breast cancer: A systematic review and meta-analysis

Wijaya¹,

Peng²,

et al. 2020

The Breast

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Background The axillary reverse mapping (ARM) technique, identify and preserve arm nodes during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND), was developed to prevent breast-cancer related lymphedema (BCRL) remains controversial. Methods A comprehensive search of Medline Ovid, Pubmed, Web of Science and the Cochrane CENTRAL databases was conducted from the inception till January 2020. The key word including “breast cancer”, “axillary reverse mapping”, and “lymphedema”. Stata 15.1 software was used for the meta-analysis. Results As a result, twenty-nine related studies involving 4954 patients met our inclusion criteria. The pooled overall estimate lymphedema incidence was 7% (95% CI 4%–11%, I 2 = 90.35%, P < 0.05), with SLNB showed a relatively lower pooled incidence of lymphedema (2%, 95% CI 1%–3%), I 2 = 26.06%, P = 0.23) than that of ALND (14%, 95% CI 5%–26%, I 2 = 93.28%, P < 0.05) or SLNB and ALND combined (11%, 95% CI 1%–30%). The ARM preservation during ALND procedure could significantly reduce upper extremity lymphedema in contrast with ARM resection (OR = 0.27, 95% CI 0.20–0.36, I 2 = 31%, P = 0.161). Intriguingly, the result favored ALND-ARM over standard-ALND in preventing lymphedema occurrence (OR = 0.21, 95% CI 0.14–0.31, I 2 = 43%, P = 0.153). The risk of metastases in the ARM-nodes was not significantly lower in the patients who had received neoadjuvant chemotherapy, as compared to those without neoadjuvant treatment (OR = 1.20, 95% CI 0.74–1.94, I 2 = 49.4%, P = 0.095). Conclusions ARM was found to significantly reduce the incidence of BCRL. The selection of patients for this procedure should be based on their axillary nodal status. Preoperative neoadjuvant chemotherapy has no significant impact on the ARM lymph node metastasis rate.

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“…Most of the research works in the state-of-the-art aim at analyzing, in a univariate manner, possible factors associated with capsular contracture after post-radiotherapy in mastectomised patients, focusing on the comparison between different reconstruction methods or therapeutic approaches. In a previous meta-analysis study [ 28 ] made by Fengzhou Du and colleagues, the authors evaluated the results of the DTI ("direct-to-implant”) and TEI (“tissue expander after implant”) procedures followed by PMRT (“post-mastectomy radiotherapy”). They found that there was not a difference in terms of rate of capsular contracture between implants and tissue expanders, and, in fact, patients who received PMRT, with permanent implant or tissue expander, showed the same risk contracture.…”

Section: Discussionmentioning

confidence: 99%

A Machine Learning Approach for Predicting Capsular Contracture after Postmastectomy Radiotherapy in Breast Cancer Patients

et al. 2023

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In recent years, immediate breast reconstruction after mastectomy surgery has steadily increased in the treatment pathway of breast cancer (BC) patients due to its potential impact on both the morpho-functional and aesthetic type of the breast and the quality of life. Although recent studies have demonstrated how recent radiotherapy techniques have allowed a reduction of adverse events related to breast reconstruction, capsular contracture (CC) remains the main complication after post-mastectomy radio-therapy (PMRT). In this study, we evaluated the association of the occurrence of CC with some clinical, histological and therapeutic parameters related to BC patients. We firstly performed bivariate statistical tests and we then evaluated the prognostic predictive power of the collected data by using machine learning techniques. Out of a sample of 59 patients referred to our institute, 28 patients (i.e., 47%) showed contracture after PMRT. As a result, only estrogen receptor status (ER) and molecular subtypes were significantly associated with the occurrence of CC after PMRT. Different machine learning models were trained on a subset of clinical features selected by a feature importance approach. Experimental results have shown that collected features have a non-negligible predictive power. The extreme gradient boosting classifier achieved an area under the curve (AUC) value of 68% and accuracy, sensitivity, and specificity values of 68%, 64%, and 74%, respectively. Such a support tool, after further suitable optimization and validation, would allow clinicians to identify the best therapeutic strategy and reconstructive timing.

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

Cited by 11 publications

References 58 publications

Comment to “Patients who report cording after breast cancer surgery are at higher risk of lymphedema: Results from a large prospective screening cohort”

Comment to “Patients who report cording after breast cancer surgery are at higher risk of lymphedema: Results from a large prospective screening cohort”

Clinical application of axillary reverse mapping in patients with breast cancer: A systematic review and meta-analysis

A Machine Learning Approach for Predicting Capsular Contracture after Postmastectomy Radiotherapy in Breast Cancer Patients

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