Deutsch Melvin, Flickinger John C
University of Pittsburgh Medical Center, UPMC Presbyterian, Department of Radiation Oncology, Pittsburgh, Pennsylvania 15213, USA.
Am J Clin Oncol. 2003 Jun;26(3):229-31. doi: 10.1097/01.COC.0000018177.75673.06.
Ipsilateral arm edema can be a troublesome adverse sequel of breast conservation therapy. We carried out a prospective study of arm edema in every patient (265) seen during a 6-month period for follow-up after radiotherapy postlumpectomy for unilateral primary breast cancer. One hundred eighty-one (181) women (68.3%) had an axillary dissection. All had radiotherapy to the breast via parallel opposed tangential beams. Only eight (3%) had additional separate portals for irradiation of nodal areas. Adjuvant systemic therapy consisted of tamoxifen alone in 127 patients (47.9%) and chemotherapy with or without tamoxifen in 60 (22.6%). Ipsilateral arm edema developed in 19 patients (7.2%). Edema was mild (1+) in 16 patients, and moderate in 3 (2+). Multivariate analysis revealed that the risk of arm edema was significantly increased in heavier women (p = 0.0016), women who had an axillary dissection (p = 0.0446), and women who received tamoxifen (p = 0.0385).
患侧手臂水肿可能是保乳治疗后令人困扰的不良后遗症。我们对单侧原发性乳腺癌乳房切除术后放疗后进行6个月随访期间所见的每一位患者（共265例）的手臂水肿情况进行了一项前瞻性研究。181名（68.3%）女性接受了腋窝淋巴结清扫术。所有患者均通过平行相对切线野对乳房进行放疗。只有8名（3%）患者有额外单独的野用于照射淋巴结区域。辅助全身治疗中，127例患者（47.9%）仅接受他莫昔芬治疗，60例患者（22.6%）接受了含或不含他莫昔芬的化疗。19例患者（7.2%）出现了患侧手臂水肿。16例患者水肿为轻度（1+），3例为中度（2+）。多因素分析显示，体重较重的女性（p = 0.0016）、接受腋窝淋巴结清扫术的女性（p = 0.0446）以及接受他莫昔芬治疗的女性（p = 0.0385）发生手臂水肿的风险显著增加。
