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Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression?

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Abstract

The purpose of this study is to evaluate arm volume measurements and clinico-pathologic characteristics of breast cancer patients to define a threshold for intervention in breast cancer-related lymphedema. We prospectively performed arm volume measurements on breast cancer patients using a Perometer. Arm measurements were performed pre- and post-operatively, and change in arm volume was quantified using a relative volume change (RVC) equation. Patient and treatment risk factors were evaluated. Cox proportional hazards models with time-dependent covariates for RVC were used to evaluate whether RVC elevations of ≥3 to <5 % or ≥5 to <10 % occurring ≤3 months or >3 months after surgery were associated with progression to ≥10 % RVC. 1,173 patients met eligibility criteria with a median of 27 months post-operative follow-up. The cumulative incidence of ≥10 % RVC at 24 months was 5.26 % (95 % CI 4.01–6.88 %). By multivariable analysis, a measurement of ≥5 to <10 % RVC occurring >3 months after surgery was significantly associated with an increased risk of progression to ≥10 % RVC (HR 2.97, p < 0.0001), but a measurement of ≥3 to <5 % RVC during the same time period was not statistically significantly associated (HR 1.55, p = 0.10). Other significant risk factors included a measurement ≤3 months after surgery with RVC of ≥3 to <5 % (p = 0.007), ≥5 to <10 % (p < 0.0001), or ≥10 % (p = 0.023), axillary lymph node dissection (ALND) (p < 0.0001), and higher BMI at diagnosis (p = 0.0028). Type of breast surgery, age, number of positive or number of lymph nodes removed, nodal radiation, chemotherapy, and hormonal therapy were not significant (p > 0.05). Breast cancer patients who experience a relative arm volume increase of ≥3 to <5 % occurring >3 months after surgery do not have a statistically significant increase in risk of progression to ≥10 %, a common lymphedema criterion. Our data support utilization of a ≥5 to <10 % threshold for close monitoring or intervention, warranting further assessment. Additional risk factors for progression to ≥10 % include ALND, higher BMI, and post-operative arm volume elevation.

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Acknowledgments

This project was supported by Award R01CA139118 (AGT), and Award P50CA089393 (AGT) from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the views of the National Cancer Institute or the National Institutes of Health. In addition, we would like to acknowledge Nadine R. Taghian, whose dedication helped expedite completion of this project. The authors are greatly appreciative of her efforts.

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The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Division of Surgical Oncology, Massachusetts General Hospital, 100 Blossom Street, Boston, MA, 02114, USA

    Michelle C. Specht & Barbara L. Smith

  2. Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Boston, MA, 02114, USA

    Cynthia L. Miller, Tara A. Russell, Melissa N. Skolny, Lauren S. Jammallo, Andrzej Niemierko, Betro T. Sadek, Mina N. Shenouda & Alphonse G. Taghian

  3. Department of Biostatistics, Massachusetts General Hospital, 100 Blossom Street, Boston, MA, 02114, USA

    Nora Horick & Dianne M. Finkelstein

  4. Department of Physical and Occupational Therapy, Massachusetts General Hospital, 100 Blossom Street, Boston, MA, 02114, USA

    Jean A. O’Toole

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  1. Michelle C. Specht
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Correspondence to Alphonse G. Taghian.

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Specht, M.C., Miller, C.L., Russell, T.A. et al. Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression?. Breast Cancer Res Treat 140, 485–494 (2013). https://doi.org/10.1007/s10549-013-2655-2

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