Side effects and complications in breast-saving therapy of breast cancer

Abstract

From 1975 to June 1987, a total of 664 women underwent breast-conserving therapy for invasive carcinoma at the University Hospital for Women, Heidelberg, FRG (562 patients: surgical procedure/radiotherapy, 102 patients: only radiotherapy). A subgroup of 203 nonselected patients was prospectively followed up for complications and side effects. The population examined was representative of the entire series with reference to age distribution, tumor stage and localisation. The mean follow-up period was 28.9 months after primary therapy. Complications of breast-conserving therapy (surgery, post-operative radiotherapy, adjuvant chemotherapy for node-positive patients) were assessed by one investigator including evaluation of a standardized patients' questionnaire. The most frequent and serious single complication was lymphedema (LE) of the arm. The incidence of severe LE (greater than or equal to 3 cm difference in circumference) was 6.4%. A total of 25.1% of all patients reported some degree of swelling of the arm. The overall LE-rate was 23.1% according to the newly introduced LE-score combining the degree of difference in circumference, individual handicap and need for physiotherapy. The LE-rate was significantly increased in patients with adjuvant chemotherapy (40.1%, p less than 0.01). General impairment of arm function was reported frequently (65.6%). Shoulder mobility was severely restricted (abduction of arm less than or equal to 90 degrees) in 3.6%. Further complaints were related to impairment of fine motor function (4.5%), shielding of the arm (15.4%), reduction in absolute force (22.1%) and/or rapid tiring of the arm (37.4%). Radiotherapy related toxicity accounted for cutaneous edema (50.3%) and fibrosis of the breast (slight: 33.8%, pronounced: 9.7%).(ABSTRACT TRUNCATED AT 250 WORDS)