2951 - Does Radiation Therapy Contribute to Breast Cancer-Related Lymphedema after Axillary Node Dissection and Simplified Lymphatic Microsurgical Preventive Healing Approach (S-LYMPHA)?
Presenter(s)
H. Kadar Sfarad1, M. Feret2, E. A. Balari3, C. Padilla4, J. V. Janin3, A. Desai3, G. Tahhan3, and E. Avisar1; 1Division of Surgical Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, 2Division of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, 3University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, 4Universidad del Norte, Barranquilla, Colombia
Purpose/Objective(s): Patients with breast cancer (BC) underdo axillary lymph node dissection (ALND) under certain indications. One of the main side effects of ALND is upper limb lymphedema (LE) that occurs in 15-40% 0f cases and can be debilitating. An objective measurement of LE is Bioimpedance spectroscopy (BIS), that produces an L-DEX Score and can detect subclinical lymphedema. There are several risk factors for developing lymphedema after ALND, among them obesity, radiation therapy, wound complication and higher age. S-LYMPHA is a preventative add on procedure at the time of ALND in which lymphatic ducts from the upper limb are connected to a venous tributary. This method has been proven to reduce incidence of lymphedema to 10%. The aim of this study was to explore the effect of different doses, fields and methods of radiation on the development of LE in patients after ALND and S-LYMPHA.
Materials/Methods: A retrospective review was undertaken of a maintained prospective database of all patients who underwent ALND and S-LYMPHA for breast cancer from 2014-2021. Demographics, clinical, surgical, pathological and radiation data were recorded for all patients. In addition, L-DEX measurements were recorded preoperatively and at 6, 9, 12 and 24 months after surgery. Multivariate logistic regression was used to analyze the correlation between clinical, demographic data and L-DEX levels to radiation doses, fields and methods.
Results: Among 97 cases, 21.6% had lymphedema based on L-DEX. Adjuvant radiation trended toward significance, with a 4.5-fold increased lymphedema risk compared to no adjuvant RT (p=0.070, OR=4.513). Among primary techniques, 3DCRT significantly increased risk (p=0.012, OR=10.000), while IMPT showed no significant difference (p=0.486, OR=2.333). The overall model was significant (?²=8.740, p=0.033).
Conclusion: 3DCRT adjuvant radiation techniques has shown to be correlated with increased rated of lymphedema after AXLD and S-LYMPHA Those findings need to be confirmed in a larger cohort in order to improve statistical power, refine treatment strategies and mitigate lymphedema risk.