Radiation therapy targets and the risk of breast cancer-related lymphedema: a systematic review and network meta-analysis

Shaitelman, Simona F.; Chiang, Yi Ju; Griffin, Kate D.; DeSnyder, Sarah M.; Smith, Benjamin D.; Schaverien, Mark V.; Woodward, Wendy A.; Cormier, Janice N.

doi:10.1007/s10549-016-4089-0

Cited by 103 publications

(82 citation statements)

References 45 publications

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“…Lymphedema of the arm occurs in 19.9% of women who undergo axillary lymph node dissection and in 5.6% of women who have a sentinel lymph node biopsy . Irradiation of the regional lymph nodes may also increase risk, particularly among patients also receiving axillary lymph node dissection . Early diagnosis of lymphedema is important for optimizing its treatment and slowing its progression .…”

Section: Selected Cancersmentioning

confidence: 99%

Cancer treatment and survivorship statistics, 2019

Miller

Nogueira

Mariotto

et al. 2019

CA A Cancer J Clinicians

3,591

2,656

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effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.

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Section: Selected Cancersmentioning

confidence: 99%

Cancer treatment and survivorship statistics, 2019

Miller

Nogueira

Mariotto

et al. 2019

CA A Cancer J Clinicians

3,591

2,656

View full text Add to dashboard Cite

show abstract

“…In contradistinction to other reports, we are seldom able to perform a lymphaticolymphatic reanastomosis which provides physiologic anterograde flow following ALND. 6 The ability to select and mobilize appropriate afferent and efferent lymphatics for coaptation is limited by a sizable gap, and reliable patency of the 31,32 In this study, 4.6% of patients with a minimum 6-month follow-up developed LE, both of whom received radiotherapy. Comparative studies are ongoing to identify the degree to which radiation impacts the development of LE following LPS.…”

Section: F I G U R E 5 Intraoperative Microsurgical Decision-making Amentioning

confidence: 66%

“…Therefore, clinical markers of LE must serve as the primary indicators of lymphatic dysfunction and disease progression. Radiotherapy is commonly administered in this subset of patients and may injure carefully preserved lymphatics and lymphaticovenous anastomoses . In this study, 4.6% of patients with a minimum 6‐month follow‐up developed LE, both of whom received radiotherapy.…”

Section: Discussionmentioning

confidence: 76%

Axillary reverse mapping and lymphaticovenous bypass: Lymphedema prevention through enhanced lymphatic visualization and restoration of flow

Schwarz

Grobmyer

Djohan

et al. 2019

Journal of Surgical Oncology

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Background A lymphedema (LE) prevention surgery (LPS) paradigm for patients undergoing axillary lymphadenectomy (ALND) was developed to protect against LE through enhanced lymphatic visualization during axillary reverse mapping (ARM) and refinement in decision making during lymphaticovenous bypass (LVB). Methods A retrospective analysis of a prospective database was performed evaluating patients with breast cancer who underwent ALND, ARM, and LVB from September 2016 to December 2018. Patient and tumor characteristics, oncologic and reconstructive operative details, complications and LE development were analyzed. Results LPS was completed in 58 patients with a mean age of 51.7 years. An average of 14 lymph nodes (LN) were removed during ALND. An average of 2.1 blue lymphatic channels were visualized with an average of 1.4 LVBs performed per patient. End to end anastomosis was performed in 37 patients and a multiple lymphatic intussusception technique in 21. Patency was confirmed 96.5% of patients. Adjuvant radiation was administered to 89% of patients. Two patients developed LE with a median follow‐up of 11.8 months. Conclusion We report on our experience using a unique LPS technique. Refinements in ARM and a systematic approach to LVB allows for maximal preservation of lymphatic continuity, identification of transected lymphatics, and reestablishment of upper extremity lymphatic drainage pathways.

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“…It has been hypothesized that this could be due to the higher dose of radiations that these patients receive in the axilla (55,57). Hence, radiation-induced necrosis is likely to be involved BCRL pathogenesis (58). A higher prevalence of BCRL has also been observed in patients treated with anti-tumor systemic drugs, such as taxanes and trastuzumab, probably due to diminished lymphatic contractility (59)(60)(61).…”

Section: Risk Stratification: Who Is Likely To Develop Bcrl?mentioning

confidence: 99%

Integrating Biological Advances Into the Clinical Management of Breast Cancer Related Lymphedema

et al. 2020

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Breast cancer-related lymphedema (BCRL) occurs in a significant number of breast cancer survivors as a consequence of the axillary lymphatics' impairment after therapy (mainly axillary surgery and irradiation). Despite the recent achievements in the clinical management of these patients, BCRL is often diagnosed at its occurrence. In most cases, it remains a progressive and irreversible condition, with dramatic consequences in terms of quality of life and on sanitary costs. There are still no validated pre-surgical strategies to identify individuals that harbor an increased risk of BCRL. However, clinical, therapeutic, and tumor-specific traits are recurrent in these patients. Over the past few years, many studies have unraveled the complexity of the molecular and transcriptional events leading to the lymphatic system ontogenesis. Additionally, molecular insights are coming from the study of the germline alterations involved at variable levels in BCRL models. Regrettably, there is a substantial lack of predictive biomarkers for BCRL, given that our knowledge of its molecular milieu remains extremely puzzled. The purposes of this review were (i) to outline the biology underpinning the ontogenesis of the lymphatic system; (ii) to assess the current state of knowledge of the molecular alterations that can be involved in BCRL pathogenesis and progression; (iii) to discuss the present and shortterm future perspectives in biomarker-based patients' risk stratification; and (iv) to provide practical information that can be employed to improve the quality of life of these patients.

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Radiation therapy targets and the risk of breast cancer-related lymphedema: a systematic review and network meta-analysis

Abstract: RNI is associated with a significantly higher risk of lymphedema than irradiation of the breast/CW, particularly after ALND.

Cited by 103 publications

References 45 publications

Cancer treatment and survivorship statistics, 2019

Cancer treatment and survivorship statistics, 2019

Axillary reverse mapping and lymphaticovenous bypass: Lymphedema prevention through enhanced lymphatic visualization and restoration of flow

Integrating Biological Advances Into the Clinical Management of Breast Cancer Related Lymphedema

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