Nielsen Hanne Melgaard, Friis Rasmus Blechingberg, Linnet Søren, Offersen Birgitte Vrou
a Department of Oncology , Aarhus University Hospital , Aarhus , Denmark.
b Department of Oncology , Herning Hospital , Herning , Denmark.
Acta Oncol. 2017 May;56(5):713-718. doi: 10.1080/0284186X.2016.1277261. Epub 2017 Jan 20.
Axillary lymph node dissection (ALND) and adjuvant radiotherapy (RT) in early breast cancer are associated with a risk of morbidity, including lymphedema and impaired shoulder mobility. The aim of this study was to evaluate loco-regional morbidity after breast conserving surgery (BCS), ALND, taxane-based chemotherapy and whole breast irradiation (WBI) with or without regional nodes RT.
Eligible patients had BCS and ALND from 2007 to 2012 followed by adjuvant taxane-based chemotherapy and if indicated, trastuzumab and endocrine treatment. The RT consisted of WBI and regional nodes RT in case of ≥ pN1 disease (group 1) and WBI only in case of pN0-1(mic) disease (group 2). The dose was 50 Gy in 25 fractions. The patients were invited to participate in a cross-sectional study evaluating morbidity.
Of the 347 eligible patients, 277 patients (79%) accepted the invitation. Of these, 185 patients (67%) belonged to group 1 and 92 patients (33%) to group 2. The median time from RT to evaluation of morbidity was 3.3 years (group 1) and 4.3 years (group 2). In group 1, 34 patients (18%) and in group 2, 15 patients (16%) had ≥2 cm enlargement in circumference of ipsilateral upper or lower arm (p = .67). The frequence of impairment of ipsilateral shoulder abduction to ≤120° was 3% in both groups and of shoulder flexion to ≤120° was 1% and 2% (group 1 versus 2). No difference in patient reported outcome measure (PROM) data regarding heaviness or enlargement of ipsilateral upper and lower arm or mobility and sensory disturbances.
The risk of lymphedema was low in patients after ALND and not related to use of regional nodes RT. Impairment of shoulder function was rare, and no differences in PROM were detected regarding use or not of regional nodes RT.
早期乳腺癌的腋窝淋巴结清扫术（ALND）和辅助放疗（RT）与包括淋巴水肿和肩部活动受限在内的发病风险相关。本研究的目的是评估保乳手术（BCS）、ALND、紫杉类化疗以及全乳照射（WBI）联合或不联合区域淋巴结放疗后的局部区域发病率。
符合条件的患者在2007年至2012年期间接受了BCS和ALND，随后接受辅助紫杉类化疗，必要时接受曲妥珠单抗和内分泌治疗。放疗包括全乳照射和在≥pN1疾病情况下的区域淋巴结放疗（第1组）以及在pN0 - 1（微转移）疾病情况下仅进行全乳照射（第2组）。剂量为25次分割共50 Gy。邀请患者参与一项评估发病率的横断面研究。
在347名符合条件的患者中，277名患者（79%）接受了邀请。其中，185名患者（67%）属于第1组，92名患者（33%）属于第2组。从放疗到发病率评估的中位时间在第1组为3.3年，在第2组为4.3年。在第1组中，34名患者（18%），在第2组中，15名患者（16%）同侧上臂或下臂周长增大≥2 cm（p = 0.67）。两组中同侧肩部外展至≤120°的受损频率均为3%，肩部前屈至≤120°的频率在第1组和第2组分别为1%和2%。在患者报告的关于同侧上臂和下臂沉重或增大以及活动和感觉障碍的结局指标（PROM）数据方面无差异。
ALND术后患者发生淋巴水肿的风险较低，且与区域淋巴结放疗的使用无关。肩部功能受损罕见，在是否使用区域淋巴结放疗方面未检测到PROM的差异。
