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Radiation Therapy Field Design and Lymphedema Risk After Regional Nodal Irradiation for Breast Cancer.

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Title: Radiation Therapy Field Design and Lymphedema Risk After Regional Nodal Irradiation for Breast Cancer.
Authors: Gross, Jeffrey P.1, Sachdev, Sean1, Helenowski, Irene B.2, Lipps, David3, Hayes, John P.1, Donnelly, Eric D.1, Strauss, Jonathan B.1 jonathan.strauss@nm.org
Source: International Journal of Radiation Oncology, Biology, Physics. Sep2018, Vol. 102 Issue 1, p71-78. 8p.
Subjects: Cancer radiotherapy, Breast cancer treatment, Lymphedema, Breast cancer patients, Biopsy, Disease risk factors, Breast tumors, Longitudinal method, Radiation carcinogenesis, Tumor classification, Relative medical risk
Abstract: Purpose: The occurrence of upper extremity lymphedema after regional nodal irradiation (RNI) for breast cancer treatment varies significantly based on patient and treatment factors. The relationship between the radiation therapy (RT) field design and lymphedema risk is not well-characterized. The present study sought to correlate the variations in RT field design with lymphedema outcomes.Methods and Materials: Women with stage II-IV breast cancer receiving RNI after breast surgery that included sentinel lymph node biopsy or axillary dissection were identified. Their arm circumference was measured before RT and at each follow-up visit to assess for lymphedema. Nodal RT fields were defined using a trifurcated system. Group 1 excluded the upper level I and II axilla, defined by the lateral border of the nodal field encompassing less than one-third of the humeral head. Group 2 included the upper level I and II axilla, defined by the lateral border of the nodal field encompassing more than one-third of the humoral head treated with an anterior oblique beam. Group 3 included the upper level I and II axilla the same as for group 2 but with parallel-opposed beams delivering a significant dose to the musculature posterior to the axilla.Results: From 1999 to 2013, 526 women received RNI. The median post-RT follow-up was 5.5 years. For the 492 women meeting the inclusion criteria, the cumulative incidence of lymphedema was 23.5% at 2 years and 31.8% at 5 years. On univariate analysis, the patients in group 1 had a lower 5-year lymphedema rate (7.7%) than those in group 2 (37.1%) and group 3 (36.7%; P < .0001). On multivariate analysis, inclusion of the upper level I and II axilla (groups 2 and 3) remained significantly associated with increased lymphedema risk.Conclusions: Variations in the RT field design significantly affect the development of lymphedema after RNI. In particular, the upper level I and II axilla appear to be important regions for lymphedema risk after axillary dissection. [ABSTRACT FROM AUTHOR]
Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Radiation Therapy Field Design and Lymphedema Risk After Regional Nodal Irradiation for Breast Cancer.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Gross%2C+Jeffrey+P%2E%22&quot;&gt;Gross, Jeffrey P.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Sachdev%2C+Sean%22&quot;&gt;Sachdev, Sean&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Helenowski%2C+Irene+B%2E%22&quot;&gt;Helenowski, Irene B.&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Lipps%2C+David%22&quot;&gt;Lipps, David&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hayes%2C+John+P%2E%22&quot;&gt;Hayes, John P.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Donnelly%2C+Eric+D%2E%22&quot;&gt;Donnelly, Eric D.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Strauss%2C+Jonathan+B%2E%22&quot;&gt;Strauss, Jonathan B.&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;i&gt; jonathan.strauss@nm.org&lt;/i&gt;
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  Data: &lt;bold&gt;Purpose: &lt;/bold&gt;The occurrence of upper extremity lymphedema after regional nodal irradiation (RNI) for breast cancer treatment varies significantly based on patient and treatment factors. The relationship between the radiation therapy (RT) field design and lymphedema risk is not well-characterized. The present study sought to correlate the variations in RT field design with lymphedema outcomes.&lt;bold&gt;Methods and Materials: &lt;/bold&gt;Women with stage II-IV breast cancer receiving RNI after breast surgery that included sentinel lymph node biopsy or axillary dissection were identified. Their arm circumference was measured before RT and at each follow-up visit to assess for lymphedema. Nodal RT fields were defined using a trifurcated system. Group 1 excluded the upper level I and II axilla, defined by the lateral border of the nodal field encompassing less than one-third of the humeral head. Group 2 included the upper level I and II axilla, defined by the lateral border of the nodal field encompassing more than one-third of the humoral head treated with an anterior oblique beam. Group 3 included the upper level I and II axilla the same as for group 2 but with parallel-opposed beams delivering a significant dose to the musculature posterior to the axilla.&lt;bold&gt;Results: &lt;/bold&gt;From 1999 to 2013, 526 women received RNI. The median post-RT follow-up was 5.5&#160;years. For the 492 women meeting the inclusion criteria, the cumulative incidence of lymphedema was 23.5% at 2&#160;years and 31.8% at 5&#160;years. On univariate analysis, the patients in group 1 had a lower 5-year lymphedema rate (7.7%) than those in group 2 (37.1%) and group 3 (36.7%; P&#160;&lt;&#160;.0001). On multivariate analysis, inclusion of the upper level I and II axilla (groups 2 and 3) remained significantly associated with increased lymphedema risk.&lt;bold&gt;Conclusions: &lt;/bold&gt;Variations in the RT field design significantly affect the development of lymphedema after RNI. In particular, the upper level I and II axilla appear to be important regions for lymphedema risk after axillary dissection. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1016/j.ijrobp.2018.03.046
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      – Code: eng
        Text: English
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        PageCount: 8
        StartPage: 71
    Subjects:
      – SubjectFull: Cancer radiotherapy
        Type: general
      – SubjectFull: Breast cancer treatment
        Type: general
      – SubjectFull: Lymphedema
        Type: general
      – SubjectFull: Breast cancer patients
        Type: general
      – SubjectFull: Biopsy
        Type: general
      – SubjectFull: Disease risk factors
        Type: general
      – SubjectFull: Breast tumors
        Type: general
      – SubjectFull: Longitudinal method
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      – SubjectFull: Radiation carcinogenesis
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      – SubjectFull: Tumor classification
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      – SubjectFull: Relative medical risk
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      – TitleFull: Radiation Therapy Field Design and Lymphedema Risk After Regional Nodal Irradiation for Breast Cancer.
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              Text: Sep2018
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              Y: 2018
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