Shaitelman Simona F, Chiang Yi-Ju, Griffin Kate D, DeSnyder Sarah M, Smith Benjamin D, Schaverien Mark V, Woodward Wendy A, Cormier Janice N
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1202, Houston, TX, 77030, USA.
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1484, Houston, TX, 77030, USA.
Breast Cancer Res Treat. 2017 Apr;162(2):201-215. doi: 10.1007/s10549-016-4089-0. Epub 2016 Dec 23.
New indications have been found for regional nodal irradiation (RNI) in breast cancer treatment, yet the relationship of RNI and lymphedema risk is uncertain. We sought to determine the association of RNI and lymphedema.
We searched MEDLINE, EMBASE, and Scopus for articles in English on humans published from 1995 to 2015, using search terms breast neoplasm, treatment, and morbidity. Two investigators independently selected articles and extracted information, including manuscripts reporting incidence of lymphedema by radiation targets. Meta-analyses, review papers, case-control studies, matched-pair studies, repetitive datasets, and retrospective studies were excluded. A total of 2399 abstracts were identified and 323 corresponding articles reviewed. Twenty-one studies met inclusion criteria. Data were pooled using a random effects mixed model. Network meta-analyses were performed to determine the association of radiation targets alone and radiation targets plus extent of axillary surgery on incidence of lymphedema.
The addition of RNI to breast/CW irradiation was associated with an increased incidence of lymphedema (OR 2.85; 95% CI 1.24-6.55). In patients treated with sentinel lymph node biopsy or axillary sampling, there was no association of lymphedema with the addition of RNI to breast/CW irradiation (OR 1.58; 95% CI 0.54-4.66; pooled incidence 5.7 and 4.1%, respectively). Among patients treated with axillary lymph node dissection (ALND), treatment with RNI in addition to breast/CW radiation was associated with a significantly higher risk of lymphedema (OR 2.74; 95% CI 1.38-5.44; pooled incidence 18.2 and 9.4%, respectively).
RNI is associated with a significantly higher risk of lymphedema than irradiation of the breast/CW, particularly after ALND.
区域淋巴结照射（RNI）在乳腺癌治疗中已发现新的适应证，但RNI与淋巴水肿风险之间的关系尚不确定。我们试图确定RNI与淋巴水肿之间的关联。
我们在MEDLINE、EMBASE和Scopus数据库中检索1995年至2015年发表的关于人类的英文文章，检索词为乳腺肿瘤、治疗和发病率。两名研究者独立筛选文章并提取信息，包括报告按放疗靶区划分的淋巴水肿发生率的手稿。排除荟萃分析、综述文章、病例对照研究、配对研究、重复数据集和回顾性研究。共识别出2399篇摘要，并对323篇相应文章进行了审查。21项研究符合纳入标准。使用随机效应混合模型汇总数据。进行网状荟萃分析以确定单独放疗靶区以及放疗靶区加腋窝手术范围与淋巴水肿发生率之间的关联。
在乳腺/CW照射基础上加用RNI与淋巴水肿发生率增加相关（比值比2.85；95%置信区间1.24 - 6.55）。在接受前哨淋巴结活检或腋窝采样的患者中，在乳腺/CW照射基础上加用RNI与淋巴水肿无关联（比值比1.58；95%置信区间0.54 - 4.66；汇总发生率分别为5.7%和4.1%）。在接受腋窝淋巴结清扫（ALND）的患者中，除乳腺/CW放疗外加用RNI治疗与淋巴水肿风险显著更高相关（比值比2.74；95%置信区间1.38 - 5.44；汇总发生率分别为18.2%和9.4%）。
与乳腺/CW照射相比，RNI与淋巴水肿风险显著更高相关，尤其是在ALND之后。
