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Radiation Dose and Lymphedema Risk After Immediate Lymphatic Reconstruction and Axillary Lymph Node Dissection.

Daphna Spiegel1, Josephine Levey1, Mario Keko2

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Regional nodal irradiation increases breast cancer related lymphedema risk after axillary lymph node dissection and lymphatic reconstruction. Higher radiation doses to the reconstruction site correlate with increased lymphedema incidence.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Radiation Oncology

Background:

  • Regional nodal irradiation (RNI) is used in breast cancer treatment.
  • RNI can increase the risk of breast cancer related lymphedema (BCRL) after axillary lymph node dissection (ALND) and immediate lymphatic reconstruction (ILR).
  • The relationship between radiation dose and BCRL after ILR requires further investigation.

Purpose of the Study:

  • To examine the association between radiation therapy (RT) dose delivered to the immediate lymphatic reconstruction (ILR) anastomosis site and the development of breast cancer related lymphedema (BCRL).

Main Methods:

  • A prospective study of 23 invasive breast cancer patients who underwent ALND/ILR followed by RNI.
  • Lymphedema was assessed based on arm volume changes and patient-reported symptoms.
  • Dosimetric parameters at the ILR site and surrounding volumes were analyzed in relation to lymphedema development.

Main Results:

  • Fourteen patients (60.9%) experienced lymphedema, with 4 (17.4%) meeting BCRL criteria at last follow-up.
  • Higher mean RT dose, V35, and V40 to the ILR + 2 cm volume were significantly associated with lymphedema.
  • Threshold doses for the ILR + 2 cm volume were identified, with significantly higher lymphedema rates above these thresholds.

Conclusions:

  • Increased RT doses to the ILR site and surrounding areas elevate the risk of lymphedema.
  • Further research is needed to determine if dose reduction below identified thresholds can decrease BCRL rates without compromising oncologic outcomes.