Factors associated with breast lymphedema after adjuvant radiation therapy in women undergoing breast conservation therapy

Factors associated with breast lymphedema after adjuvant radiation therapy in women undergoing breast conservation therapy

Breast lymphedema after post-lumpectomy radiation therapy (RT) is poorly defined and difficult to treat. The aim of this study was to define the incidence of breast lymphedema and identify factors associated with the risk of developing breast lymphedema (BL) in women undergoing breast-conserving the...

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Veröffentlicht in:Breast (Edinburgh) 2025-02, Vol.79, p.103846, Article 103846
Hauptverfasser: Yono, Summer Sami, Cannella, Cara, Gonte, Madeleine, Rama, Sanjay, Zhu, Simeng, Luker, Jenna, Evangelista, Maristella S., Bensenhaver, Jessica, Walker, Eleanor M., Atisha, Dunya
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container_start_page 103846
container_title Breast (Edinburgh)
container_volume 79
creator Yono, Summer Sami
Cannella, Cara
Gonte, Madeleine
Rama, Sanjay
Zhu, Simeng
Luker, Jenna
Evangelista, Maristella S.
Bensenhaver, Jessica
Walker, Eleanor M.
Atisha, Dunya
description Breast lymphedema after post-lumpectomy radiation therapy (RT) is poorly defined and difficult to treat. The aim of this study was to define the incidence of breast lymphedema and identify factors associated with the risk of developing breast lymphedema (BL) in women undergoing breast-conserving therapy. A retrospective cohort study of patients with early-stage breast cancer who underwent breast-conserving surgery (lumpectomy) followed by RT between January 1, 2014 and July 31, 2019 at a single institution. Women who developed BL, defined as swelling of the breast persisting ≥1 year after RT, were compared with women who did not. Univariate and multivariate regression analyses were used to identify factors associated with risk of BL. A total of 1052 patients were included in the study: 99 (9.6 %) developed BL and 953 (90.6 %) did not develop BL. The mean ± standard deviation age was 62.9 ± 11.1 years and the mean breast volume was 1352.0 ± 744.9 cm3. Patients with breast volume ≥1500 cm3 (adjusted odds ratio [aOR] = 2.34; 95 % CI, 1.40–3.91; p = 0.001), Black patients (aOR = 1.78; 95 % CI, 1.12–2.82; p = 0.015), those who received neoadjuvant (aOR = 3.05; 95 % CI, 1.28–7.30; p = 0.012) or adjuvant chemotherapy (aOR = 2.14; 95 % CI, 1.29–3.55; p = 0.003), those with postoperative cellulitis (aOR = 3.94; 95 % CI, 2.20–7.06; p 
doi_str_mv 10.1016/j.breast.2024.103846
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The aim of this study was to define the incidence of breast lymphedema and identify factors associated with the risk of developing breast lymphedema (BL) in women undergoing breast-conserving therapy. A retrospective cohort study of patients with early-stage breast cancer who underwent breast-conserving surgery (lumpectomy) followed by RT between January 1, 2014 and July 31, 2019 at a single institution. Women who developed BL, defined as swelling of the breast persisting ≥1 year after RT, were compared with women who did not. Univariate and multivariate regression analyses were used to identify factors associated with risk of BL. A total of 1052 patients were included in the study: 99 (9.6 %) developed BL and 953 (90.6 %) did not develop BL. The mean ± standard deviation age was 62.9 ± 11.1 years and the mean breast volume was 1352.0 ± 744.9 cm3. Patients with breast volume ≥1500 cm3 (adjusted odds ratio [aOR] = 2.34; 95 % CI, 1.40–3.91; p = 0.001), Black patients (aOR = 1.78; 95 % CI, 1.12–2.82; p = 0.015), those who received neoadjuvant (aOR = 3.05; 95 % CI, 1.28–7.30; p = 0.012) or adjuvant chemotherapy (aOR = 2.14; 95 % CI, 1.29–3.55; p = 0.003), those with postoperative cellulitis (aOR = 3.94; 95 % CI, 2.20–7.06; p &lt; 0.001), and women who developed arm lymphedema (aOR = 2.94; 95 % CI, 1.50–5.77; p = 0.002) had significantly higher odds of developing BL. Patients with larger breast volumes, Black patients, those receiving chemotherapy, and those who develop arm lymphedema or cellulitis may be at higher risk of BL after lumpectomy and RT, suggesting that patients with these risk features may benefit from complementary or alternative surgical approaches and heightened monitoring to avoid BL. •Among 1052 women who underwent BCT, 9.6 % developed breast lymphedema, defined as breast swelling persisting for one year or more post-radiotherapy, emphasizing the prevalence and persistence of the complication.•The study identified several key risk factors for developing breast lymphedema, including larger breast volume (≥1500 cm³), Black race, use of neoadjuvant and adjuvant chemotherapy, postoperative cellulitis, and concurrent arm lymphedema.•The study suggests that patients with such risk factors might benefit from alternative surgical approaches and increased monitoring to prevent breast lymphedema, underscoring the need for personalized care strategies in managing breast lymphedema post-lumpectomy and radiation therapy.</description><identifier>ISSN: 0960-9776</identifier><identifier>ISSN: 1532-3080</identifier><identifier>EISSN: 1532-3080</identifier><identifier>DOI: 10.1016/j.breast.2024.103846</identifier><identifier>PMID: 39580932</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Original</subject><ispartof>Breast (Edinburgh), 2025-02, Vol.79, p.103846, Article 103846</ispartof><rights>2024 The Authors</rights><rights>Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.</rights><rights>2024 The Authors 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c343t-25d045d8dd17c9c72a3489ef1618c264ed836a5afa7704cc82b5f34fb6b381873</cites><orcidid>0009-0001-2010-9754</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11625242/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.breast.2024.103846$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,3550,27924,27925,45995,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39580932$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yono, Summer Sami</creatorcontrib><creatorcontrib>Cannella, Cara</creatorcontrib><creatorcontrib>Gonte, Madeleine</creatorcontrib><creatorcontrib>Rama, Sanjay</creatorcontrib><creatorcontrib>Zhu, Simeng</creatorcontrib><creatorcontrib>Luker, Jenna</creatorcontrib><creatorcontrib>Evangelista, Maristella S.</creatorcontrib><creatorcontrib>Bensenhaver, Jessica</creatorcontrib><creatorcontrib>Walker, Eleanor M.</creatorcontrib><creatorcontrib>Atisha, Dunya</creatorcontrib><title>Factors associated with breast lymphedema after adjuvant radiation therapy in women undergoing breast conservation therapy</title><title>Breast (Edinburgh)</title><addtitle>Breast</addtitle><description>Breast lymphedema after post-lumpectomy radiation therapy (RT) is poorly defined and difficult to treat. The aim of this study was to define the incidence of breast lymphedema and identify factors associated with the risk of developing breast lymphedema (BL) in women undergoing breast-conserving therapy. A retrospective cohort study of patients with early-stage breast cancer who underwent breast-conserving surgery (lumpectomy) followed by RT between January 1, 2014 and July 31, 2019 at a single institution. Women who developed BL, defined as swelling of the breast persisting ≥1 year after RT, were compared with women who did not. Univariate and multivariate regression analyses were used to identify factors associated with risk of BL. A total of 1052 patients were included in the study: 99 (9.6 %) developed BL and 953 (90.6 %) did not develop BL. The mean ± standard deviation age was 62.9 ± 11.1 years and the mean breast volume was 1352.0 ± 744.9 cm3. Patients with breast volume ≥1500 cm3 (adjusted odds ratio [aOR] = 2.34; 95 % CI, 1.40–3.91; p = 0.001), Black patients (aOR = 1.78; 95 % CI, 1.12–2.82; p = 0.015), those who received neoadjuvant (aOR = 3.05; 95 % CI, 1.28–7.30; p = 0.012) or adjuvant chemotherapy (aOR = 2.14; 95 % CI, 1.29–3.55; p = 0.003), those with postoperative cellulitis (aOR = 3.94; 95 % CI, 2.20–7.06; p &lt; 0.001), and women who developed arm lymphedema (aOR = 2.94; 95 % CI, 1.50–5.77; p = 0.002) had significantly higher odds of developing BL. Patients with larger breast volumes, Black patients, those receiving chemotherapy, and those who develop arm lymphedema or cellulitis may be at higher risk of BL after lumpectomy and RT, suggesting that patients with these risk features may benefit from complementary or alternative surgical approaches and heightened monitoring to avoid BL. •Among 1052 women who underwent BCT, 9.6 % developed breast lymphedema, defined as breast swelling persisting for one year or more post-radiotherapy, emphasizing the prevalence and persistence of the complication.•The study identified several key risk factors for developing breast lymphedema, including larger breast volume (≥1500 cm³), Black race, use of neoadjuvant and adjuvant chemotherapy, postoperative cellulitis, and concurrent arm lymphedema.•The study suggests that patients with such risk factors might benefit from alternative surgical approaches and increased monitoring to prevent breast lymphedema, underscoring the need for personalized care strategies in managing breast lymphedema post-lumpectomy and radiation therapy.</description><subject>Original</subject><issn>0960-9776</issn><issn>1532-3080</issn><issn>1532-3080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><recordid>eNp9kU1v1DAQhiMEokvhHyDkI5cs_orjXECoooBUiQucrYk92fUqsRfb2Wr59aRKW9ELJ1v2M8-M5q2qt4xuGWXqw2HbJ4RctpxyuTwJLdWzasMawWtBNX1ebWinaN21rbqoXuV8oJR2QumX1YXoGr3c-ab6cw22xJQJ5Byth4KO3PqyJ6ucjOfpuEeHExAYCiYC7jCfIBSSwC24j4GUPSY4nokP5DZOGMgcHKZd9GH3oLExZEynJ_zr6sUAY8Y39-dl9ev6y8-rb_XNj6_frz7f1FZIUWreOCobp51jre1sy0FI3eHAFNOWK4lOCwUNDNC2VFqred8MQg696oVmuhWX1afVe5z7CZ3FUBKM5pj8BOlsInjz9Cf4vdnFk2FM8YZLvhje3xtS_D1jLmby2eI4QsA4ZyOY4Ip2vNULKlfUpphzwuGxD6PmLjdzMOtOzF1uZs1tKXv374yPRQ9BLcDHFcBlUyePyWTrMVh0PqEtxkX__w5_Ad9dr5k</recordid><startdate>20250201</startdate><enddate>20250201</enddate><creator>Yono, Summer Sami</creator><creator>Cannella, Cara</creator><creator>Gonte, Madeleine</creator><creator>Rama, Sanjay</creator><creator>Zhu, Simeng</creator><creator>Luker, Jenna</creator><creator>Evangelista, Maristella S.</creator><creator>Bensenhaver, Jessica</creator><creator>Walker, Eleanor M.</creator><creator>Atisha, Dunya</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0009-0001-2010-9754</orcidid></search><sort><creationdate>20250201</creationdate><title>Factors associated with breast lymphedema after adjuvant radiation therapy in women undergoing breast conservation therapy</title><author>Yono, Summer Sami ; 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The aim of this study was to define the incidence of breast lymphedema and identify factors associated with the risk of developing breast lymphedema (BL) in women undergoing breast-conserving therapy. A retrospective cohort study of patients with early-stage breast cancer who underwent breast-conserving surgery (lumpectomy) followed by RT between January 1, 2014 and July 31, 2019 at a single institution. Women who developed BL, defined as swelling of the breast persisting ≥1 year after RT, were compared with women who did not. Univariate and multivariate regression analyses were used to identify factors associated with risk of BL. A total of 1052 patients were included in the study: 99 (9.6 %) developed BL and 953 (90.6 %) did not develop BL. The mean ± standard deviation age was 62.9 ± 11.1 years and the mean breast volume was 1352.0 ± 744.9 cm3. Patients with breast volume ≥1500 cm3 (adjusted odds ratio [aOR] = 2.34; 95 % CI, 1.40–3.91; p = 0.001), Black patients (aOR = 1.78; 95 % CI, 1.12–2.82; p = 0.015), those who received neoadjuvant (aOR = 3.05; 95 % CI, 1.28–7.30; p = 0.012) or adjuvant chemotherapy (aOR = 2.14; 95 % CI, 1.29–3.55; p = 0.003), those with postoperative cellulitis (aOR = 3.94; 95 % CI, 2.20–7.06; p &lt; 0.001), and women who developed arm lymphedema (aOR = 2.94; 95 % CI, 1.50–5.77; p = 0.002) had significantly higher odds of developing BL. Patients with larger breast volumes, Black patients, those receiving chemotherapy, and those who develop arm lymphedema or cellulitis may be at higher risk of BL after lumpectomy and RT, suggesting that patients with these risk features may benefit from complementary or alternative surgical approaches and heightened monitoring to avoid BL. •Among 1052 women who underwent BCT, 9.6 % developed breast lymphedema, defined as breast swelling persisting for one year or more post-radiotherapy, emphasizing the prevalence and persistence of the complication.•The study identified several key risk factors for developing breast lymphedema, including larger breast volume (≥1500 cm³), Black race, use of neoadjuvant and adjuvant chemotherapy, postoperative cellulitis, and concurrent arm lymphedema.•The study suggests that patients with such risk factors might benefit from alternative surgical approaches and increased monitoring to prevent breast lymphedema, underscoring the need for personalized care strategies in managing breast lymphedema post-lumpectomy and radiation therapy.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>39580932</pmid><doi>10.1016/j.breast.2024.103846</doi><orcidid>https://orcid.org/0009-0001-2010-9754</orcidid><oa>free_for_read</oa></addata></record>
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title Factors associated with breast lymphedema after adjuvant radiation therapy in women undergoing breast conservation therapy
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