Meek A G
Department of Radiation Oncology, University Medical Center, Stony Brook, New York 11794-7028, USA.
Cancer. 1998 Dec 15;83(12 Suppl American):2788-97. doi: 10.1002/(sici)1097-0142(19981215)83:12b+<2788::aid-cncr27>3.3.co;2-9.
Breast radiotherapy has a low incidence of long term complications. Lymphedema is the most commonly reported complication and adversely affects the quality of life of the breast carcinoma patient. Although its incidence is decreasing, lymphedema still remains a significant concern for patients and their physicians. With the indications for radiotherapy in breast carcinoma management broadening, current strategies to prevent radiation-related lymphedema should be applied and new strategies should be developed.
A review of the literature addressing lymphedema as a complication of radiotherapy in breast carcinoma management was performed.
Arm, breast, and truncal edema occur after primary breast carcinoma management. The literature supports the view that radiotherapy contributes to arm and breast edema. Lymphedema occurs most commonly in patients who have both axillary radiotherapy and surgery, is often triggered by a soft tissue infection, and is more common in obese patients. The incidence of arm edema is decreasing due to more conservative surgical treatment of the axilla and possibly due to more conservative management of the breast. Trends in breast edema are less discernible. Single-modality treatment of the axilla is associated with a very low incidence of arm edema.
Lymphedema continues to be a problem in the care of the breast carcinoma patient. More conservative surgery combined with careful patient selection for nodal radiotherapy reduces its incidence. Radiotherapy technique, prompt treatment of soft tissue infections, and weight loss in obese patients each can contribute to prevention. The risk of lymphedema is greatly surpassed by the benefits of radiotherapy in the care of the breast carcinoma patient.
乳腺癌放疗的长期并发症发生率较低。淋巴水肿是最常报道的并发症，对乳腺癌患者的生活质量有不利影响。尽管其发生率在下降，但淋巴水肿仍是患者及其医生极为关注的问题。随着乳腺癌治疗中放疗适应证的扩大，应采用当前预防放射性淋巴水肿的策略并开发新策略。
对有关淋巴水肿作为乳腺癌治疗中放疗并发症的文献进行综述。
原发性乳腺癌治疗后会出现手臂、乳房和躯干水肿。文献支持放疗会导致手臂和乳房水肿的观点。淋巴水肿最常发生在接受腋窝放疗和手术的患者中，常由软组织感染引发，在肥胖患者中更常见。由于对腋窝采用更保守的手术治疗以及可能对乳房采用更保守的处理，手臂水肿的发生率正在下降。乳房水肿的趋势较难辨别。腋窝的单模态治疗与极低的手臂水肿发生率相关。
淋巴水肿仍是乳腺癌患者护理中的一个问题。更保守的手术结合仔细选择进行淋巴结放疗的患者可降低其发生率。放疗技术、及时治疗软组织感染以及肥胖患者减重均有助于预防。在乳腺癌患者护理中，放疗的益处远远超过淋巴水肿的风险。
