Clinical Analysis Of Upper-body Morbidity After Postoperative Radiotherapy In Breast Cancer Patients

Objective: To identify the probability of breast cancer-related arm lymphedema(BCRL) and impairments of shoulder function induced by radiotherapy in patients afterbreast cancer surgery and to analyze the relative risk factors contributing to development ofBCRL.Methods: A total of92patients with breast cancer were treated with lumpectomy ormodified radical mastectomy and afterwards conformal radiotherapy in our hospital. Thedetermination of upper-body morbidity was based on subjective symptoms felt by patientsand objective signs viewed. FCAT-B+4scoring system was introduced to commentpatients’ symptoms and circumference measurement was taken at15cm below theacromion process and15cm below the olecranon in both arms, impairments of shoulderfunction is assessed along with self reports of activities of daily living and range ofmotion.Then the actuarial rates of upper-body morbidity were determined.Univariateanalysis was performed by Chi-Square test, and multivariable analysis was undertaken bybinary logistic regression.Results: The actuarial rate of complains and signs of BCRL was respectively53.3%and32.6%, while being57.6%and65.2%in impairments of shoulder function. BCRL wasmore likely to develop in patients with advanced nodal status(41.5%vs.11.1%, P=0.005),patients with stage Ⅲ(52.5%vs.17.3%, P=0), and patients receiving supraclavicularirradiation (37.8%vs.11.1%, P=0.03). Stage is the independent risk factor leading tolymphedema after multivariable analysis.Conclusions: These results suggest that upper-body morbidity is the commoncomplication with high morbidity induced by postoperative radiotherapy. The risk factors of BCRL include advanced nodal status, late stage and supraclavicular irradiation,whichmay raise BCRL, which emphasizes the importance of further efforts to reduce the dose ofnormal tissue.