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Some secondary analysis from prevent landing in different...

  1. Twjaxon
    148 Posts.
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    13/10/23
    09:19
    Post #: 70322768
    Some secondary analysis from prevent landing in different journals.

    Radiation Oncology Orals - 2023 - Journal of Medical Imaging and Radiation Oncology - Wiley Online Library

    Axillary Treatment and Chronic Breast Cancer–Related Lymphedema: Implications for Prospective Surveillance and Intervention From a Randomized Controlled Trial | JCO Oncology Practice (ascopubs.org)

    Regional node irradiation treatment volumes and chronic breast Cancer-Related Lymphoedema: Results from a randomised controlled trial

    J Boyages, F Vicini, L Koelmeyer, S Ridner and C Shah

    Icon Cancer Centre, Wahroonga, New South Wales, Australia

    Purpose: The PREVENT randomised controlled trial assessed progression to chronic breast cancer-related lymphoedema (cBCRL) following intervention triggered by bioimpedance spectroscopy (BIS) or tape measurement (TM) screening for subclinical BCRL (sBCRL) (1). This secondary analysis identifies the risk of cBCRL based on the extent of regional node irradiation (RNI) for patients treated with sentinel node biopsy (SNB) or axillary lymph node dissection (ALND).

    Methods and Materials: Between 24 June 2014 and 11 September 2018, 881 patients received axillary treatment classified as sentinel node biopsy (SNB, n = 651, 73.9%), SNB + RNI, (n = 58, 6.6%), ALND, (n = 85, 9.6%) or ALND + RNI (n = 87, 9.9%). Post-operative BIS or TM assessments were scheduled at regular follow-up visits. An L-Dex unit change of ≥6·5 or TM volume change ≥5- < 10% “triggered” sBCRL and initiated a four-week, 12-hour/day, compression sleeve and gauntlet. The primary outcome was the 3-year rate of cBCRL, defined as the need for Complex Lymphoedema Therapy (CLT), with a TM ≥10% volume change. Four women identified themselves as Aboriginal/Torres Strait Islander (ATSI).

    Results: Patients with SNB alone were more likely to be Stage 0/1 (73·4%), and those with ALND+RNI were more likely to be Stage II/III (98·8%). After a median follow-up of 32·8 months, 69 of 881 patients (7·8%) developed cBCRL. For TM, 43 of 438 (9·8%) developed cBCRL versus 26 of 443 (5·9%) for BIS (p = 0·028). The 3-year actuarial risk of cBCRL was 4·4%, 4·2%, 25·8%, and 26% respectively for SNB, SNB + RNI, ALND, and ALND+RNI. Rural residence increased the risk in all groups. One of four Aboriginal and Torres Strait Islander (ATSI) women developed cBCRL.

    For SNB, neither RNI (SNB: 4·1% vs SNB + RNI: 3·4%) nor taxane (4·4%) increased the risk of cBCRL, but risk was higher for patients with body mass index (BMI) ≥30 (6·3%). For SNB + RNI, taxane use (5·7%) or supraclavicular fossa (SCF) radiation (5·0%) increased cBCRL. For ALND patients, BMI ≥25 or chemotherapy increased cBCRL. Eight of 50 patients (16%) who had an ALND developed cBCRL compared to 18 of 82 treated with ALND + SCF radiation (22%) (p = 0.3).

    Conclusion: The extent of axillary surgery rather than radiation is the most significant risk factor for cBCRL. Increasing BMI, rurality, SCF radiation, and taxane chemotherapy are other risk factors. BIS surveillance is associated with significantly lower rates of cBCRL than TM and is easily applied in the clinic. A risk-based lymphoedema education, screening, early intervention, and treatment program is proposed.

    ReferencesRidner SH, Dietrich MS, Boyages J et al. A comparison of bioimpedance spectroscopy or tape measure triggered compression intervention in chronic breast cancer lymphedema prevention. Lymphatic Research and Biology. 2022 Dec 1;20(6):618–28.
    IPD Price at posting: 14.5¢ Sentiment: Buy Disclosure: Held
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