Why Radiation is a risk for lymphedema

kira66715

I  did a medical literature review and discovered that whole breast radiation delivers a fair amount of radiation to the level I/II axillary nodes, and a recent article by physicians from Dana Farber, in the journal Oncology stated:

WBI is usually delivered via tangent fields using high-energy x-rays. Forward planning techniques allow addition of sub-fields to optimize dose homogeneity; intensity-modulated radiotherapy (IMRT) is typically not required. Standard tangent fields cover a substantial percentage of level I and II axillary nodes. “High tangent” techniques can be used to treat a greater percentage of the axilla. 

(Definitions: WBI=whole breast radiation, tangents are the lines of the radiation fields--specifically the upper limit.)

I developed lymphedema prior to radiation and discovered my tangent was high--at the head of my humerus--and called my rad onc in a panic and was told that "radiation to the level I/II nodes never causes lymphedema" That's just not true.

I posted the details and some images on the LE thread, and would suggest that any women with node negative cancer discuss how much radiation to the axilla is anticipated with their radiation planning.

Unfortunately, radiated lymph nodes don't recover, if they get a full dose of radiation. 

Each woman gets an individualized plan, and should know the full details.

http://community.breastcancer.org/forum/64/topic/793591?page=1#idx_1  This is the link to the post on the lymphedema thread.

Clearly, radiation decreases recurrence, and I made a decision to pursue breast conservation, but I wish I'd been fully informed and a partner in the decision making and my radiation oncologist had bothered to read the literature.

Recent letter to the editor in the NE Journal about prone positioning at NYU and how it takes the heart and lungs--and to my view--axillary nodes--out of the field.

Kira

GingerAmy

Kira,

Thank you for this information.

I have chronic lymphedema in my right lower leg, have since an accident at age 12. At times it has been 3+ pitting ( you can imagine how that was in my teen years..in the 80's when medical science ruled out any kidney, liver or heart issues, and had no answer for me!).

I found that rigorous exercise and daily doses of Dandelion (or Milk Thistle ) keeps it at near normal.

However, now I have had a left breast lumpectomy and subsequent sentinel node biopsy, and had to have the area drained because it was enormous after 2 weeks. I have a good sized egg under my arm with an "axillary web" starting next to it.

I was just mapped today for radiation.

I'm so scared it will begin a cycle of lifelong lymphedema in this area, since I seem already predisposed.

I'm 40; I work out regularly with weights and kick boxing but is there anything I should or shouldn't do?

I'm heading to the lymphedema section for advice, just wanted to ask you personally for suggestions (you seem pretty knowledgable!

Thank you!

Amy

kira66715

Amy, sorry for the delay, I didn't see your post. 

A few of us from the lymphedema thread started a web site, and we have a page on AWS/axillary web syndrome--which definitely can be made worse by a seroma

http://www.stepup-speakout.org/Cording_and_Axillary_Web_Syndrome.htm 

As far as exercise--it's good, but too much can bring on swelling, so you have to be careful not to fatigue yourself--carol57 has the best posts on exercise--when we get lymph nodes removed, seromas, radiation, it reduces our body's ability to handle lymph fluid in that "quadrant"--for lymph drainage the body is divided into 4 parts, like chicken quarters, the upper quadrants are the arm/breast/trunk/back on each side.

Here's a link to risk reduction:

http://www.stepup-speakout.org/riskreduction_for_lymphedema.htm 

Some of us have a genetic predisposition to get it, and it's hard to know who we are ahead of time.

If you have lymphedema in your leg, perhaps you have a good lymphedema therapist who can check you out and show you how to do gentle lymph drainage in your arm

http://www.stepup-speakout.org/Finding_a_Qualified_Lymphedema_Therapist.htm

You know, there was no real lymphadema treatment in this country until the last decade or so, it got brought over from Germany. It must have been terrible to manage it as a teen, with essentially no help.

Please come over to the lymphedema thread (the group no one wants to join, believe me), because forewarned is forearmed.

Kira