Lymphatic Bypass in Patients Receiving Regional Nodal Radiation

Abstract

<h3>Purpose/Objective(s)</h3> An estimated 40% of breast cancer patients undergoing axillary lymph node dissection (ALND) and nodal radiation (RT) develop upper extremity breast cancer related lymphedema (BCRL.) The goal of the lymphatic microsurgical preventive healing approach (LYMPHA,) which creates a lymphatic venous anastomosis, reducing interstitial volume and improving lymphatic drainage, <i>at the time of ALND</i> is to mitigate the development of BCRL, thereby improving quality of life for breast cancer survivors. We hypothesize that patients who received LYMPHA will have lower rates of BCRL over those who did not receive LYMPHA. <h3>Materials/Methods</h3> A total of 54 patients were retrospectively evaluated in this IRB approved study. All patients underwent axillary lymph node dissection and adjuvant regional nodal radiation. Twenty-seven patients underwent LYMPHA during their initial oncological surgery and a matched paired control cohort of 27 patients who did not undergo LYMPHA were evaluated. <h3>Results</h3> The average age of patients who did and did not undergo LYMPHA was 54 and 52, respectively. The total number of nodes dissected in patients that underwent LYMPHA versus those who did not was 17 and 15, respectively. The average BMI for patients that underwent LYMPHA versus those who did not was the same at 28 kg/m² for both groups. The average mean dose to axillary levels I through III in all patients was 4124 cGy. The average max dose to axillary levels I through III in all patients was 4780 cGy. 7 patients in both groups developed breast cancer related lymphedema (BCRL). The average number of days status post last RT fraction for BCRL to develop/first clinical documentation was 462 and 571 days in the LYMPHA and no LYMPHA group, respectively. <h3>Conclusion</h3> The rates of BCRL between the two groups were not different as initially hypothesized. One proposed reason for this is that patients on the LYMPHA protocol were monitored very closely for any signs of BCRL, while the matched control BCRL rates may be underestimated. This study warrants further investigation to be presented in a poster, as dosimetric evaluation may reveal sparing of particular portions of the lymphatic bypass can optimize outcomes in regard to BCRL.