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Risk of Lymphedema Following Contemporary Treatment for Breast Cancer: An Analysis of 7617 Consecutive Patients From a Multidisciplinary Perspective

Authors
 Hwa Kyung Byun  ;  Jee Suk Chang  ;  Sang Hee Im  ;  Youlia M. Kirova  ;  Alexandre Arsene-Henry  ;  Seo Hee Choi  ;  Young Up Cho  ;  Hyung Seok Park  ;  Jee Ye Kim  ;  Chang-Ok Suh  ;  jj Ki Chang Keum  ;  Joo Hyuk Sohn  ;  Gun Min Kim  ;  Ik Jae Lee  ;  Jun Won Kim  ;  Yong Bae Kim 
Citation
 EUROPEAN JOURNAL OF CARDIOVASCULAR PREVENTION & REHABILITATION, : epub., 2019 
Journal Title
 EUROPEAN JOURNAL OF CARDIOVASCULAR PREVENTION & REHABILITATION 
ISSN
 1741-8267 
Issue Date
2019
Abstract
OBJECTIVE: The aim of this study was to identify the comprehensive risk factors for lymphedema, thereby enabling a more informed multidisciplinary treatment decision-making. SUMMARY BACKGROUND DATA: Lymphedema is a serious long-term complication in breast cancer patients post-surgery; however, the influence of multimodal therapy on its occurrence remains unclear. METHODS: We retrospectively collected treatment-related data from 5549 breast cancer patients who underwent surgery between 2007 and 2015 at our institution. Individual radiotherapy plans were reviewed for regional nodal irradiation (RNI) field design and fractionation type. We identified lymphedema risk factors and used them to construct nomograms to predict individual risk of lymphedema. Nomograms were validated internally using 100 bootstrap samples and externally using 2 separate datasets of 1877 Asian and 191 Western patients. RESULTS: Six hundred thirty-nine patients developed lymphedema during a median follow-up of 60 months. The 3-year lymphedema incidence was 10.5%; this rate increased with larger irradiation volumes (no RNI vs RNI excluding axilla I-II vs RNI including axilla I-II: 5.7% vs 16.8% vs 24.1%) and when using conventional fractionation instead of hypofractionation (13.5% vs 6.8%). On multivariate analysis, higher body mass index, larger number of dissected nodes, taxane-based regimen, total mastectomy, larger irradiation field, and conventional fractionation were strongly associated with lymphedema (all P < 0.001). Nomograms constructed based on these variables showed good calibration and discrimination internally (concordance index: 0.774) and externally (0.832 for Asian and 0.820 for Western patients). CONCLUSIONS: Trimodality breast cancer treatment factors interact to promote lymphedema. Lymphedema risk can be decreased by deintensifying node dissection, chemotherapy regimen, and field and dose of radiotherapy. Deescalation strategies on a multidisciplinary basis might minimize lymphedema risk.
Full Text
https://insights.ovid.com/pubmed?pmid=31348041
DOI
10.1097/SLA.0000000000003491
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Kim, Gun Min(김건민) ORCID logo https://orcid.org/0000-0001-9167-8682
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Kim, Jun Won(김준원) ORCID logo https://orcid.org/0000-0003-1358-364X
Kim, Jee Ye(김지예) ORCID logo https://orcid.org/0000-0003-3936-4410
Park, Hyung Seok(박형석) ORCID logo https://orcid.org/0000-0001-5322-6036
Byun, Hwa Kyung(변화경) ORCID logo https://orcid.org/0000-0002-8964-6275
Suh, Chang Ok(서창옥)
Sohn, Joo Hyuk(손주혁) ORCID logo https://orcid.org/0000-0002-2303-2764
Lee, Ik Jae(이익재) ORCID logo https://orcid.org/0000-0001-7165-3373
Im, Sang Hee(임상희) ORCID logo https://orcid.org/0000-0001-5128-5526
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
Cho, Young Up(조영업) ORCID logo https://orcid.org/0000-0003-2936-410X
Choi, Seo Hee(최서희) ORCID logo https://orcid.org/0000-0002-4083-6414
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175667
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