Breast radiotherapy and lymphedema

BACKGROUND, Breast radiotherapy has a low incidence of long term complicati ons. Lymphedema is the most commonly reported complication and adversely af fects the quality of life of the breast carcinoma patient. Although its inc idence is decreasing, lymphedema still remains a significant concern for pa tients and their physicians. With the indications for radiotherapy in breas t carcinoma management broadening, current strategies to prevent radiation- related lymphedema should be applied and new strategies should be developed . METHODS, A review of the literature addressing lymphedema as a complication of radiotherapy in breast carcinoma management was performed. RESULTS. Arm, breast, and truncal edema occur after primary breast carcinom a management. The literature supports the view that radiotherapy contribute s to arm and breast edema. Lymphedema occurs most commonly in patients who have both axillary radiotherapy and surgery, is often triggered by a soft t issue infection, and is more common in obese patients. The incidence of arm edema is decreasing due to more conservative surgical treatment of the axi lla and possibly due to more conservative management of the breast. Trends in breast edema are less discernible. Single-modality treatment of the axil la is associated with a very low incidence of arm edema. CONCLUSIONS, Lymphedema continues to be a problem in the care of the breast carcinoma patient. More conservative surgery combined with careful patient selection for nodal radiotherapy reduces its incidence. Radiotherapy techn ique, prompt treatment of soft tissue infections, and weight loss in obese patients each can contribute to prevention. The risk of lymphedema is great ly surpassed by the benefits of radiotherapy in the care of the breast carc inoma patient. Cancer 1998; 83:2788-97. (C) 1998 American Cancer Society.