Sayegh Hoda E, Asdourian Maria S, Swaroop Meyha N, Brunelle Cheryl L, Skolny Melissa N, Salama Laura, Taghian Alphonse G
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA.
Curr Breast Cancer Rep. 2017 Jun;9(2):111-121. doi: 10.1007/s12609-017-0237-8. Epub 2017 May 3.
Breast cancer-related lymphedema (BCRL) is a chronic, adverse, and much feared complication of breast cancer treatment, which affects approximately 20% of patients following breast cancer treatment. BCRL has a tremendous impact on breast cancer survivors, including physical impairments and significant psychological consequences. The intent of this review is to discuss recent studies and analyses regarding the risk factors, diagnosis, prevention through early screening and intervention, and management of BCRL.
Highly-evidenced risk factors for BCRL include axillary lymph node dissection, lack of reconstruction, radiation to the lymph nodes, high BMI at diagnosis, weight fluctuations during and after treatment, subclinical edema within and beyond 3 months after surgery, and cellulitis in the at-risk arm. Avoidance of potential risk factors can serve as a method of prevention. Through establishing a screening program by which breast cancer patients are measured pre-operatively and at follow-ups, are objectively assessed through a weight-adjusted analysis, and are clinically assessed for signs and symptoms, BCRL can be tracked accurately and treated effectively. Management of BCRL is done by a trained professional, with research mounting towards the use of compression bandaging as a first line intervention against BCRL. Finally, exercise is safe for breast cancer patients with and without BCRL and does not incite or exacerbate symptoms of BCRL.
Recent research has shed light on BCRL risk factors, diagnosis, prevention, and management. We hope that education on these aspects of BCRL will promote an informed, consistent approach and encourage additional research in this field to improve patient outcomes and quality of life in breast cancer survivors.
乳腺癌相关淋巴水肿（BCRL）是乳腺癌治疗的一种慢性、不良且令人恐惧的并发症，约20%的乳腺癌患者在治疗后会受到影响。BCRL对乳腺癌幸存者有巨大影响，包括身体损伤和严重的心理后果。本综述旨在讨论关于BCRL的风险因素、诊断、通过早期筛查和干预进行预防以及管理的近期研究和分析。
BCRL的高度证据化风险因素包括腋窝淋巴结清扫、未进行重建、淋巴结放疗、诊断时BMI高、治疗期间及治疗后体重波动、术后3个月内及3个月后的亚临床水肿以及患侧手臂蜂窝织炎。避免潜在风险因素可作为一种预防方法。通过建立一个筛查项目，对乳腺癌患者在术前和随访时进行测量，通过体重调整分析进行客观评估，并对体征和症状进行临床评估，可准确追踪并有效治疗BCRL。BCRL的管理由经过培训的专业人员进行，越来越多的研究倾向于将加压包扎作为对抗BCRL的一线干预措施。最后，运动对有或无BCRL的乳腺癌患者都是安全的，不会引发或加重BCRL的症状。
近期研究揭示了BCRL的风险因素、诊断、预防和管理。我们希望关于BCRL这些方面的教育将促进一种明智、一致的方法，并鼓励该领域的更多研究，以改善乳腺癌幸存者的患者结局和生活质量。
