Breast Cancer

PV 01 - Poster Viewing Q&A - Session 1

SU_11_2109 - The Rate of Lymphedema and Predictive Factors in the Setting of Neoadjuvant Chemotherapy and Adjuvant Radiation Therapy in Breast Cancer Patients

Sunday, September 15
1:15 PM - 2:30 PM
Location: ASTRO Innovation Hub

The Rate of Lymphedema and Predictive Factors in the Setting of Neoadjuvant Chemotherapy and Adjuvant Radiation Therapy in Breast Cancer Patients
B. Altoos Jr1, T. Refaat Abdelrhman Jr1, Y. Ho2, M. Wesolowski3, W. Small Jr1, and T. O. Thomas Jr1; 1Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 2Loyola University Chicago Stritch School of Medicine, Maywood, IL, 3Loyola University Medical Center, Maywood, IL

Purpose/Objective(s): The rate of lymphedema is better delineated in literature among breast cancer (BC) patients treated with adjuvant chemotherapy and radiation therapy (RT). This study aimed to evaluate the incidence and identify predictors of lymphedema in BC patients treated with Neoadjuvant Chemotherapy (NAC) and adjuvant RT.

Materials/Methods: We retrospectively identified BC patients treated with NAC consecutively from 2006 to 2018 at our institution. Univariable and multivariable binary logistic regression analyses were performed to estimate the effects of sex, age, race, body mass index (BMI), diabetes status, clinical stage, chemotherapy response, type of surgery, RT coverage and other predictors on lymphedema outcomes. Predictors that demonstrated significant effects in univariable analyses were included in the multivariable model. Adjusted variables included BMI, diabetes, clinical stage, chemotherapy response, type of surgery, and RT coverage.

Results: This IRB approved study included 286 BC patients who received NAC and had documented lymphedema status. Lymphedema was evaluated using patient arm circumference before RT and at follow up visits. Median follow up was 28.4 months. 78 patients (27.3%) were identified with lymphedema while 208 patients (72.7%) remained without lymphedema at their last reported follow up visit. Predictors significant on univariable analysis were BMI (>35), patients with diabetes, initial clinical stage (locally advanced), chemotherapy response (patients with residual nodal disease), type of surgery (axillary lymph node dissection vs sentinel nodal biopsy) and radiation coverage (axillary nodal coverage of axillary I-II vs omitting coverage of axillary I-II). On multivariable analysis, only type of surgery remained statistically significant. Those who had an axillary lymph node dissection had 30% rate of lymphedema versus patients with a sentinel nodal biopsy had rates that were much lower (~10%).

Conclusion: This is one of the largest studies to look at the incidence and predictors of lymphedema among BC patients treated with NAC. In our study, we demonstrated that patients undergoing NAC have rates of lymphedema that reflect historical lymphedema rates in the adjuvant chemotherapy setting. Multiple predictors of lymphedema were present on univariable analysis but only the type of surgery remained statistically significant on multivariable analysis.

Author Disclosure: B. Altoos: None. T. Refaat Abdelrhman: None. Y. Ho: None. M. Wesolowski: None. W. Small: Honoraria; Zeiss. Research Grant; Zeiss. Travel Expenses; Zeiss. Chair; GCIG. Co-Chai Gyn Working Group; RTOG. Co-Chair Gynecology Committee; NRG Oncology. CSC Member; ACR. T.O. Thomas: None.

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