Abstract
Background: When a patient with breast cancer-related lymphedema (BCRL) depends on continuous compression management, that is, when interstitial fluid accumulation is continuously ongoing, surgical treatment should be considered. Physiologic surgery is considered more effective for early-stage lymphedema. The purpose of this study was to identify predictors of patients with BCRL who will be compression-dependent despite 2 years of conservative care. Methods: This study included patients with BCRL who followed up for 2 years. Patients were classified into two groups (compression-dependent vs. compression-free). We identified the proportion of compression-dependent patients and predictors of compression dependence. Results: Among 208 patients, 125 (60.1%) were classified into the compression-dependent group. Compression dependence was higher in patients with direct radiotherapy to the lymph nodes (LNs), those with five or more LNs resections, and those with BCRL occurring at least 1 year after surgery. Conclusions: BCRL patients with direct radiotherapy to the LNs, extensive LN dissection, and delayed onset may be compression-dependent despite 2 years of conservative care. Initially moderate to severe BCRL and a history of cellulitis also seem to be strongly associated with compression dependence. Our results allow for the early prediction of compression-dependent patients who should be considered for physiologic surgery.
Highlights
Lymphedema is a chronic and debilitating condition characterized by excess protein-rich fluid accumulation in interstitial tissues due to impairment of the lymphatic system
BMI, body mass index; MSC, middle school certificate; HSC, high school certificate; CDT, complex decongestive therapy; BCRL, breast cancer-related lymphedema; PEC, percentage of excess circumference; BIA, bioimpedance analysis; ECF, extracellular fluid; SFBIA, single frequency bioimpedance; ECW, extracellular water volume; TBW, total body water volume. a Data for 1 patient were unknown or not reported. b Data for 71 patients were unknown or not reported. c Data for 5 patients were unknown or not reported. d BIA was performed in 196 patients
Of the swelling-related characteristics, dependence on compression was significantly associated with delayed-onset BCRL occurring at more than 1 year after surgery (OR, 2.961; 95% confidence interval (CI), 1.282–6.834) and with initially moderate to severe lymphedema, meaning PEC values above 10 (OR, 6.375; 95% CI, 1.432–28.378)
Summary
Lymphedema is a chronic and debilitating condition characterized by excess protein-rich fluid accumulation in interstitial tissues due to impairment of the lymphatic system. A secondary condition, known as breast cancer-related lymphedema (BCRL), is the most common form Breast cancer treatment, such as lymph node dissection and radiotherapy, damages regional lymphatic circulation and can lead to BCRL, which presents as breast and arm swelling. Previous studies have reported that up to 40% of patients with breast cancer develop lymphedema [1,2,3,4]. When a patient with breast cancer-related lymphedema (BCRL) depends on continuous compression management, that is, when interstitial fluid accumulation is continuously ongoing, surgical treatment should be considered. The purpose of this study was to identify predictors of patients with BCRL who will be compression-dependent despite 2 years of conservative care. Conclusions: BCRL patients with direct radiotherapy to the LNs, extensive LN dissection, and delayed onset may be compression-dependent despite 2 years of conservative care. Our results allow for the early prediction of compression-dependent patients who should be considered for physiologic surgery
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