Prevalence of Lymphedema and Associated Risk Factors Following Multimodal Breast Cancer Treatment

Abstract

Background: Breast cancer related Lymphedema (BCRL) in the respective arm is a common but serious negative sequel of breast cancer management. Risk factors include dissection of Axillary lymph nodes and irradiation of Regional lymph nodes. Nearly 20% of patients receiving treatment of breast cancer develop this complication and it has a negative impact on quality of life of the patient. Objective: Current study aims to equip the medical professionals with all the details needed for prevention, early detection, intervention and management of this hazardous late treatment related complication. Material and Methods: Total 350 breast cancer patients (with their consent) treated at Government Cancer Hospital, Indore in the Radiotherapy and Oncology Department, in period from January 2019till December 2021, with chest wall radiotherapy following subsequent hormonal therapy, as needed. Patients then analysed for occurrence of lymphedema. Subsequently, efforts were given for finding out the correlation between lymphedema and related treatment modality like adjuvant radiotherapy following definitive surgery with number of excised lymph nodes and number of involved lymph nodes, chemotherapy, hormonal therapy, subjective co-morbid condition (obesity, diabetes mellitus and high blood pressure). Results: Current study demonstrate a significant correlation of adjuvant radiotherapy, including progressive involvement of the lymph node stations, with radical or conservative breast surgery with lymph node dissection represents a statistically significant risk factor, with relative risk, RR=1.49 (95% CI=0.72–3.05), p<0.001. Subsequent increase in number of dissected lymph nodes shown a risk factor with statistical significance as relative risk for more than 25 removed lymph nodes, demonstrated significant risk of lymphedema than for 16-25 removed lymph nodes. Other analysed risk factors, which did not influence lymphedema development like, associated chemotherapy, hormonal therapy or presence of co-morbid illnesses. Conclusions: Arm lymphedema is a late sequel associated with carcinoma breast treatment using radiation or surgery, and quite capricious occurrence that can happen years after axillary clearance surgery. With the use of sentinel node sampling, could reduce the need of frank axillary clearance by showing either involvement of lymph node in axilla, so as to manage only by radiotherapy. That significantly reduces the risk of lymphedema from 16% with axillary clearance to 5% without dissection. Keywords: Lymphedema, Breast cancer, Risk factors, Axillary lymph node