The Incidence and Risk Factors for occurrence of Arm Lymphedema after Treatment of Breast Cancer

Background: The arm lymphedema is reported as being themost frequent late reaction and complication thatinfluences breast cancer patients’ quality of life after lymphnode dissection and radiotherapy. The aim of the study is toidentify the risk factors in arm lymphedema occurrence inbreast cancer patients who performed radical conservatorysurgery, chemotherapy and radiotherapy.Material and Methods: We analysed 305 breast cancer patientswho underwent treatment in the „Sf. Ap. Andrei” EmergencyClinical Hospital, Galati, Radiotherapy and Oncology Department, between the 1st of January 2010 and 31st ofDecember 2012. We tried to find the risk factors for armlymphedema development after treatment of breast cancer: theassociation of adjuvant radiotherapy with surgery, chemotherapy,hormonal therapy, number of removed lymph nodes,and number of lymph nodes with metastases, the co-morbidillnesses (obesity, diabetes mellitus and high blood pressure).Results: Our study evidences that the association of adjuvantradiotherapy, including the lymph node regions, with radicalor conservatory surgery with lymph node dissection representsa statistically significant risk factor, with relative risk, RR =1.87, 95%C.I.=1.39â€"3.51, p 0.001. The number of removedlymph nodes was found to be a risk factor with statisticalsignificance. For more than 25 removed lymph nodes, therelative risk for arm lymphedema development was RR=1.95(95%C.I. =1.79â€"4.51) and for 16-25 removed lymph nodesthe relative risk, RR = 1.78, 95% C.I. = 1.46 â€" 3.23. Otheranalysed risk factors, which did not influence lymphedemadevelopment, were: associated chemotherapy or hormonaltherapy,presence of co-morbid illnesses.Conclusions: The development of arm lymphedema is an unpredictableoccurrence that can happen years after axillary surgery.Breast and arm oedema continue to be late reactions that canbe reduced by use of biopsy sentinel technique with avoiding ofaxillary lymph node dissection, when the sentinel lymph nodeis negative, knowing that lymphedema risk after sentinel lymphnode is 5% comparative with lymphedema risk after axillarylymph node dissection which is 16%, by avoiding obesity, andperforming modern therapy techniques.

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