Ocena zaleznosci pomiedzy zaawansowaniem raka piersi i sposobem leczenia przeciwnowotworowego a ryzykiem wystapienia obrzeku limfatycznego

Abstract

Author(s): Tomasz Wojewoda, Jerzy Mitus, Aleksandra Grela-Wojewoda, Wojciech M Wysocki

Introduction: Radical surgical therapy of breast cancer associated with necessary removal of axillary lymph nodes, combined with irradiation, may cause development of severe early and delayed complications, including lymphoedema of the upper limb. The therapy of lymphatic edema is life-long. Therefore it is highly important to select the group of patients post radical therapy of breast cancer, in which development of lymphoedema is the most probable as early as possible.

Objective: Assessment of an association between the applied anti-cancer therapy and the risk of lymphoedema of the upper limb based on lymphoscintigraphic evaluation of own material. Methods. Clinical material of 77 randomly selected patients post radical breast cancer therapy was analyzed. The patients were prospectively followed-up, and the mean observation time after conclusion of the therapy was 36 months. Metric measurements and diagnostic investigations – lymphoscintigraphy – were performed during that period.

Results: In 47 of 77 patients (61%) there were clinical symptoms of lymphoedema, and in 30 patients (39%) no symptoms were observed. In patients with clinical lymphatic edema lymphoscintigraphy revealed signs of lymphatic failure, and flow asymmetry index was abnormal. The applied anti-cancer therapy (that is, type of surgery, chemotherapy, radiotherapy and hormonal therapy) is not significantly correlated with development of lymphoedema, or with the flow asymmetry index (p >0.05 in all cases). The association between application of chemotherapy and development of lymphoedema shows a tendency for significance (p = 0.078). The number of lymph nodes removed during the surgery and occupied by metastases are not significantly associated with both development of lymphoedema and the flow asymmetry index (p >0.05 in all cases). The association between the number of metastatic lymph nodes and development of lymphoedema tends to be significant (p = 0.057).

Conclusions: The applied anti-cancer therapy (radiotherapy, chemotherapy, hormonal therapy), lateralization of cancer as well as pT and pN traits are not associated with an increased risk of upper limb lymphoedema in patients operated on because of breast cancer, with removal of the lymphatic system of the axillary fossa.

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