lymphedema and radiation

tamD

Can any one tell me where to find what the risk is for lymphedema if you have had sentinel node biopsy, then chemo and radiation. 

What is the risk of lymphedema if you had auxiliary node dissection, chemo but NO radiation.

Lastly, what is the risk of lymphedema if you have auxiliary node dissection, chemo AND radiation.

  Although I had 2 positive nodes with sentinel node biopsy and large tumor size my oncologist is recommending no more surgery after chemo -- just radiation.  At first I thought there was less risk of lymphedema this way if there is no aux. node dissection.  Is this true or does radiation pose as much risk as the aux node dissection.  I know the 2 combined are not good.  Any info would help. Thanks

Tam

kira66715

Tam, I don't know if anyone has firm numbers for you: there was recently a risk calculator released at the ASCO meeting, but it was only for axillary lymph node dissection. Although I just had a SNB, I ran it for interest sake. I believe it's not active right now, until the article is published.

Here's an analysis of the study on bc.org

http://www.breastcancer.org/tips/new_research/20110908.jsp

Here's a recent study that says they're all risk factors, but no hard numbers--this study had 8% diagnosed with LE and 37% with symptoms but no formal diagnosis--as there is no one diagnositic criteria for LE, you'll see wide variation in incidence numbers:

http://www.ncbi.nlm.nih.gov/pubmed/21761159

Breast Cancer Res Treat. 2011 Jul 15. [Epub ahead of print]
Risk factors for lymphedema in breast cancer survivors, the Iowa Women's Health Study.
Ahmed RL, Schmitz KH, Prizment AE, Folsom AR.
Source

Department of Dermatology, University of Minnesota, Mayo Mail Code 98, 420 Delaware Street SE, Minneapolis, MN, 55455-0392, USA, ahme0056@umn.edu.
Abstract

Risk factors for lymphedema and related arm symptoms in breast cancer (BC) survivors have not been examined using a large prospective population-based cohort. The Iowa Women's Health Study (IWHS) collected self-reported data for diagnosed lymphedema in 2004, and data for cancer diagnosis, treatment, behavioral and health characteristics between 1986 and 2003. We studied 1,287 women, aged 55-69 at baseline, who developed unilateral BC: n = 104 (8%) with diagnosed lymphedema, n = 475 (37%) with arm symptoms but without diagnosed lymphedema, and n = 708 without lymphedema. Age- and multivariate-adjusted logistic regression models examined risk factors for lymphedema and related arm symptoms (OR [95% confidence interval]). The mean time between BC and the 2004 survey was 8.1 ± 5.0 (mean ± SD) years. After multivariate adjustment, the following cancer characteristics were positively associated with lymphedema: tumor stage (regional vs. in situ: 3.92 [1.61-9.54]), number of excised nodes (highest vs. lowest quintile: 3.52 [1.32-9.34], P (trend) = 0.003), tumor-positive nodes (yes vs. no 2.12 [1.19, 3.79]), and adjuvant chemotherapy (yes vs. no: 3.05 [1.75-5.30]). Several health characteristics were positively associated with lymphedema: baseline body mass index (highest vs. lowest tertile: 3.24 [1.70-6.21]), waist and hip circumference, and general health (fair/poor vs. excellent: 3.44 [1.30-9.06]). Positive associations with arm symptoms were number of excised nodes (highest vs. lowest quintile: 2.38 [1.41-4.03], P (trend) = 0.007), axillary radiation (yes vs. no: 1.72 [1.15-2.57]), and baseline general health (fair/poor vs. excellent: 4.27 [2.60-7.00]). In the IWHS, obesity, poorer general health, and markers of more advanced cancer were risk factors for lymphedema and related arm symptoms in BC survivors.

I think your onc is using the Guiliano study to say that further surgery is not going to improve survival and can lead to LE.

Maybe Binney has more hard facts.

I work in rad onc, and have seen patients get an ALND and rads to the nodes, and lately, it's much more conservative. 

Good luck with hard choices. 

Kira

Binney4

Tam, I don't have any hard facts either. As Kira mentions, percentages have little meaning for a condition that has no agreed-upon diagnositic criteria.

There have been studies to identify risk factors, though, and you're right that rads is one of them. So are post-surgical complications like infection, seroma or cording. Also obesity, previous trauma to the chest (including previous surgeries), diabetes or other vascular conditions, and some believe that treatment on the dominant side is more likely to result in lymphedma. There are also other factors that can't be identified prior to treatment, like the functional level of one's lymphatics even before bc. (Some researchers have tried to identify that factor by asking questions like whether your hands swell when you're hiking, or your feet swell readily on air flights, but the jury's still out on the reliability of any such assessment.)

So unfortunately your own risk is not currently quantifiable. But there are steps you can take to protect yourself whatever treatment decision you make. Best idea is to get a referral from any member of your medical team to a well-trained lymphedema therapist for baseline arm measurement, personalized risk assessment, and individualized risk reduction strategies. Here's how to find a qualified lymphedema therapist near you:
http://www.stepup-speakout.org/Finding_a_Qualified_Lymphedema_Therapist.htm

I'm really sorry I can't be of more help in answering your concerns. Wishing you no "swell" days ever!
Binney