Correlation Study Between Postoperative Padiotherapy And The Function Of The Affected Upper Limb And Shoulder Joint In The Acute Response Period Of Radiotherapy In Breast Cancer Patients

Objective(s)To explore the effect of postoperative radiotherapy for breast cancer on upper extremity lymphedema and shoulder joint dysfunction during the acute response phase of radiotherapy.Method(s)We retrospectively collected and analyzed 56 patients who were diagnosed primary BC then received surgery and adjuvant radiotherapy between April 2020 and December 2020.After 3 months of radiotherapy,we measured arm circumferences of both side upper limb and shoulder range of motion of the affected side shoulder,by referring the American Physical Therapy Association’s upper limb lymphedema grading standard and the Chinese Rehabilitation Medicine Diagnosis and Treatment Code to diagnose upper extremity lymphedema and shoulder joint dysfunction.According to surgery types,we divided patients into breast conserving group and modified radical mastectomy group,axillary lymph node dissection group and non-axillary lymph node dissection group.According to radiaton fields,we divided patients into affected breast irradiation group and chest wall irradiation group,supra/infraclavicular regeion irradiation group and non-supra/infraclavicular regeion irradiation group,internal mammary regeion radiation group and non-internal mammary regeion radiation.To study the effects of radiation field and dosimetry factors on upper limb lymphedema and shoulder joint dysfunction in the acute response phase of patients with postoperative radiotherapy.Result(s)(1)Of the 56 patients,12.5%(7/56)patients developed lymphedema,96.4%(54/56)developed SJD.Internal mammary regeion radiation,dosimetry of axilla level Ⅱ,level Ⅲ,axillary cavity were significantly different in lymphedema(P﹤0.05),and dosimetry of axilla level I,level Ⅱ,axillary cavity were significantly different in decreased shoulder range of motion(P﹤0.05).(2)In 40 patients who received axillary lymph node dissection and supra/infraclavicular regeion irradiation,dosimetry of axilla level Ⅲ,axillary cavity displayed differences in lymphedema,and dosimetry of axilla level I,level Ⅱ,level Ⅲ,axillary cavity were significantly different in decreased shoulder range of motion(P﹤0.05).(3)In 22 patients who received breast conserving surgery and affected breast irradiation,internal mammary regeion radiation showed difference in lymphedema(P﹤0.05).(4)In 34 patients who received mastectomy and chest wall irradiation,dosimetry of axilla level Ⅲ,axillary cavity showed differences in lymphedema,and dosimetry of axilla level I,level Ⅱ,level Ⅲ,axillary cavity were significantly different in decreased shoulder range of motion(P﹤0.05).(5)In 21 patients who received axillary lymph node dissection and internal mammary regeion radiation,modified radical mastectomy surgery,chest wall irradiation,dosimetry of axilla level Ⅲ,axillary cavity displayed differences in lymphedema,and dosimetry of axilla level I,level Ⅱ,axillary cavity were significantly different in decreased shoulder range of motion(P﹤0.05).(6)In univariate analysis,axillary lymph node dissection,internal mammary regeion radiation,modified radical mastectomy surgery,Dmin and D/V of axilla level I,axillary cavity were risk factors to decreased range of motion(P﹤0.05),and Dmin of axilla level I was a significant related factor of shoulder joint dysfunction.Conclusion(s)(1)The occurrence of lymphoedema in patients with internal mammary radiation is related with modified radical resection,chest wall radiation and dosimetry.(2)Patients who received breast conserving surgery followed by internal mammary regeion radiation was more capable to occur lymphedema.(3)In patients with axillary lymph node dissection,regional lymph node radiation was associated with decreased shoulder range of motion.Axilla surgery combined with radiation of the regional lymphatic area was more likely to lead to shoulder motion restriction.(4)In patients received axillary lymph node dissection,regional lymph node radiation,high dosimetry of lymphatic drainage area was more likely to cause shoulder joint dysfunction.(5)axillary lymph node dissection,internal mammary regeion radiation,modified radical mastectomy surgery,dosimetry of axilla level I,axillary cavity could increase the risk of shoulder joint dysfunction.