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Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy.


ABSTRACT: PURPOSE:Lymphedema is a potential complication of breast cancer treatment. This longitudinal substudy aimed to prospectively assess arm measurements and symptoms following neoadjuvant chemotherapy and axillary dissection in the ACOSOG/Alliance Z1071 trial to characterize the optimal approach to define lymphedema. METHODS:Z1071 enrolled patients with cT0-4, N1-2, M0 disease treated with neoadjuvant chemotherapy. All patients underwent axillary dissection. Bilateral limb volumes, circumferences, and related symptoms were assessed pre-surgery, 1-2 weeks post-surgery, and semiannually for 36 months. Lymphedema definitions included volume increase ??10% or limb circumference increase ??2 cm. Symptoms were assessed by the Lymphedema Breast Cancer Questionnaire. RESULTS:In 488 evaluable patients, lymphedema incidence at 3 years by ??10%-volume-increase was 60.3% (95% CI 55.0-66.2%) and by ??2 cm-circumference increase was 75.4% (95% CI 70.8-80.2%). Symptoms of arm swelling and heaviness decreased from post-surgery for the first 18 months and then were relatively stable. The 3-year cumulative incidence of arm swelling and heaviness was 26.0% (95% CI 21.7-31.1%) and 30.9% (95% CI 26.3-36.3%), respectively. There was limited agreement between the two measurements (kappa 0.27) and between symptoms and measurements (kappa coefficients ranging from 0.05-0.09). CONCLUSIONS:Lymphedema incidence by limb volume and circumference gradually increased over 36 months post-surgery, whereas lymphedema symptoms were much lower. These findings underscore the importance of prospective surveillance and evaluation of both limb measurements and symptom assessment. Lymphedema incidence rates varied by definition. We recommend that ??10% volume change criterion be used for lymphedema evaluation for referral for specialist care. TRIAL REGISTRATION:NCT00881361.

SUBMITTER: Armer JM 

PROVIDER: S-EPMC6342501 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy.

Armer Jane M JM   Ballman Karla V KV   McCall Linda L   Armer Nathan C NC   Sun Yuanlu Y   Udmuangpia Tipparat T   Hunt Kelly K KK   Mittendorf Elizabeth A EA   Byrd David R DR   Julian Thomas B TB   Boughey Judy C JC  

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 20180706 2


<h4>Purpose</h4>Lymphedema is a potential complication of breast cancer treatment. This longitudinal substudy aimed to prospectively assess arm measurements and symptoms following neoadjuvant chemotherapy and axillary dissection in the ACOSOG/Alliance Z1071 trial to characterize the optimal approach to define lymphedema.<h4>Methods</h4>Z1071 enrolled patients with cT0-4, N1-2, M0 disease treated with neoadjuvant chemotherapy. All patients underwent axillary dissection. Bilateral limb volumes, ci  ...[more]

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