ARM MORBIDITY AFTER SECTOR RESECTION AND AXILLARY DISSECTION WITH OR WITHOUT POSTOPERATIVE RADIOTHERAPY IN BREAST-CANCER STAGE .1. RESULTS FROM A RANDOMIZED TRIAL

The incidence and time course of arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy to the breast was assessed in a prospective randomised trial among 381 pa tients with stage I breast cancer. At 3-12 months, arm symptoms were r eported by 59/110 of the patients who had greater than or equal to 10 lymph nodes found in the axillary specimen versus 85/253 in whom <10 l ymph nodes were found (P = 0.002); at 13-36 months, the corresponding figures were 35/106 versus 44/225 (P = 0.001). Postoperative wound com plications increased the incidence of arm symptoms at 3-12 months from 104/283 to 39/79 at 3-12 months (P = 0.03). Employed patients and pat ients <65 years of age reported arm symptoms at 3-12 months in 86/161 and 94/191 compared to 58/207 and 50/177 among retired patients and pa tients greater than or equal to 65 years of age, respectively (P = 0.0 001 and P = 0.0002, respectively). In a multivariate logistic regressi on analysis at 3-12 months, only young age (relative risk = 0.93 per y ear of increasing age, 95% CI 0.91-0.97) and the number of lymph nodes found in the axillary specimen (relative risk = 1.11 per lymph node f ound, 95% CI 1.05-1.18) remained statistically significant. No negativ e impact on arm morbidity was found by the addition of postoperative r adiotherapy only to the breast, either in univariate or multivariate m odels. We conclude that factors directly related to the extent of the surgical procedure and young age are determinants of arm morbidity aft er breast preserving treatment for stage I breast cancer. Arm symptoms are most common during the first year after treatment and are reduced over the subsequent 2-3 years by around 40-50%. (C) 1997 Elsevier Sci ence Ltd.