Arm Edema after Lumpectomy and Breast Irradiation

Abstract

Purpose: To determine patient and treatment factors associated with the development of arm edema following lumpectomy +/− axillary dissection and breast irradiation for unilateral breast carcinoma. Materials and Methods: Two hundred sixty-five (265) women who presented for followup in a six month period after having been treated with lumpectomy +/- axillary dissection and post-operative breast irradiation for unilateral breast cancer were evaluated carefully by a single physician for the presence of arm edema. The median age at time of surgery was 61 years (range 28–85 years). At the time of evaluation, the followup interval from surgery ranged from 3–249 months (median 70). Lumpectomy was the surgical procedure in 84, whereas 181 had lumpectomy and axillary dissection. All patients were treated with whole breast irradiation using two opposed parallel tangential beams. Only eight patients (3%) were treated with additional radiotherapy to at least one nodal area. Adjuvant systemic therapy was administered to 188 patients. Tamoxifen alone was the treatment for 127 (47.9%) and 60 patients (22.6%) were treated with chemotherapy +/- Tamoxifen. Results: Arm edema was present in 19 patients (7.2%). By multi-variate analysis, there were three factors which correlated with the development of arm edema: Increased weight, P = 0.0016, axillary dissection, P = 0.0446, and the administration of Tamoxifen, P = 0.0385. All cases of arm edema were considered to be either mild or moderate. There were no severe cases with associated functional impairments. Conclusions: Arm edema after lumpectomy +/- axillary dissection and breast irradiation is a relatively rare occurrence, especially if the axilla is not irradiated after an axillary dissection. The edema usually is mild and is just an adverse cosmetic sequelae without functional impairments.