Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2022 Oct;29(10):6370-6378. doi: 10.1245/s10434-022-12142-7. Epub 2022 Jul 19.
Breast cancer-related lymphedema (BCRL) is a debilitating sequela of breast cancer treatment and is becoming a greater concern in light of improved long-term survival. Inflammatory breast cancer (IBC) is a rare and aggressive malignancy for which systemic therapy, surgery, and radiotherapy remain the standard of care, thereby making IBC patients highly susceptible to developing BCRL. This study evaluated BCRL in IBC following trimodal therapy.
IBC patients treated from 2016 to 2019 were identified from an institutional database. Patients were excluded if they presented with recurrent disease, underwent bilateral axillary surgery, did not complete trimodal therapy, or were lost to follow-up. Demographic, clinicopathologic factors, oncologic outcomes, and perometer measurements were recorded. BCRL was defined by clinician diagnosis and/or objective perometer measurements when available. Time to development of BCRL and treatment received were captured.
Eighty-three patients were included. Median follow-up was 33 months. The incidence of BCRL was 50.6% (n = 42). Mean time to BCRL from surgery was 13 (range 2-24) months. Demographic and clinicopathologic features were similar between patients with and without BCRL with exception of higher proportion receiving delayed reconstruction in the BCRL group (38.1% vs. 14.6%, p = 0.03). Forty patients (95.2%) underwent BCRL treatment, which included physical therapy (n = 39), compression (n = 38), therapeutic lymphovenous bypass (n = 13), and/or vascularized lymph node transfer (n = 12).
IBC patients are at high-risk for BCRL after treatment, impacting 51% of patients in this cohort. Strategies to reduce or prevent BCRL and improve real-time diagnosis should be implemented to better direct early management in this patient population.
乳腺癌相关淋巴水肿（BCRL）是乳腺癌治疗的一种使人虚弱的后遗症，并且随着长期生存的改善，它变得越来越令人关注。炎性乳腺癌（IBC）是一种罕见且侵袭性的恶性肿瘤，其系统治疗、手术和放疗仍然是标准的治疗方法，因此使 IBC 患者极易发生 BCRL。本研究评估了三模式治疗后 IBC 中的 BCRL。
从机构数据库中确定了 2016 年至 2019 年接受治疗的 IBC 患者。如果患者出现复发疾病、接受双侧腋窝手术、未完成三模式治疗或失访，则将其排除在外。记录了人口统计学、临床病理因素、肿瘤学结果和周径测量值。BCRL 通过临床医生诊断和/或有客观周径测量值时定义。记录 BCRL 的发展时间和接受的治疗。
共纳入 83 例患者。中位随访时间为 33 个月。BCRL 的发生率为 50.6%（n = 42）。从手术到 BCRL 的平均时间为 13 个月（范围 2-24）。患有和不患有 BCRL 的患者之间的人口统计学和临床病理特征相似，但在 BCRL 组中接受延迟重建的比例更高（38.1%比 14.6%，p = 0.03）。40 例患者（95.2%）接受了 BCRL 治疗，其中包括物理治疗（n = 39）、压迫（n = 38）、治疗性淋巴静脉旁路（n = 13）和/或血管化淋巴结转移（n = 12）。
IBC 患者在治疗后发生 BCRL 的风险很高，本队列中有 51%的患者受到影响。应实施减少或预防 BCRL 的策略，并改善实时诊断，以便更好地指导该患者人群的早期管理。
