Abstract
Breast-conserving surgery (BCS) is commonly used in breast cancer treatment. Despite its benefits, some women will be troubled by breast edema. Breast edema may cause an unsatisfactory cosmetic result, influencing the quality of life. The purpose of this systematic review is to investigate the incidence of breast edema and to identify risk factors of breast edema in breast cancer patients following BCS and radiotherapy. A systematic literature search was performed using different electronic databases (PubMed, Web of Science, Cochrane, Embase) until June 2014. Inclusion criteria were as follows: (1) research studies that included female breast cancer patients who were treated with BCS and radiotherapy and (2) studies that investigated the incidence of breast edema and/or risk factors of breast edema. Exclusion criteria were (1) reviews or case studies and (2) studies published before 1995. We identified in total 28 papers which represented 4,011 patients. There was a great variation in the incidence of breast edema (0–90.4 %). We identified several possible risk factors for breast edema namely increasing irradiated breast volume, increasing boost volume, the use of a photon boost, increasing breast separation, a higher density of the breast tissue, a large tumor, a higher specimen weight, postoperative infection, acute postoperative toxicity, and diabetes mellitus. However, their prognostic value remains uncertain. Breast edema is a common complaint after BCS and radiotherapy. A number of possible risk factors associated with breast edema were identified, but further research is warranted.
Similar content being viewed by others
References
Lazovich D, Solomon CC, Thomas DB, Moe RE, White E (1999) Breast conservation therapy in the United States following the 1990 National Institutes of Health Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma. Cancer 86:628–637
Olivotto IA, Weir LM, Kim-Sing C, Bajdik CD, Trevisan CH, Doll CMl, Lam WY, Basco VE, Jackson SM (1996) Late cosmetic results of short fractionation for breast conservation. Radiother Oncol 41:7–13
Harsolia A, Kestin L, Grills I, Wallace M, Jolly S, Jones C, Lala M, Martinez A, Schell S, Vicini FA (2007) Intensity-modulated radiotherapy results in significant decrease in clinical toxicities compared with conventional wedge-based breast radiotherapy. Int J Radiat Oncol Biol Phys 68:1375–1380
Adriaenssens N, Belsack D, Buyl R, Ruggiero L, Breucq C, De Mey J, Lievens P, Lamote J (2012) Ultrasound elastography as an objective diagnostic measurement tool for lymphoedema of the treated breast in breast cancer patients following breast conserving surgery and radiotherapy. Radiol Oncol 46:284–295
Adriaenssens N, Verbelen H, Lievens P, Lamote J (2012) Lymphedema of the operated and irradiated breast in breast cancer patients following breast conserving surgery and radiotherapy. Lymphology 45:154–164
Toledano A, Garaud P, Serin S, Fourquet A, Bosset JF, Breteau N, Body G, Azria D, Le Floch O, Calais G (2006) Concurrent administration of adjuvant chemotherapy and radiotherapy after breast-conserving surgery enhances late toxicities: long-term results of the ARCOSEIN multicenter randomized study. Int J Radiat Oncol Biol Phys 65:324–332
Pezner RD, Patterson MP, Hill LR, Desai KR, Vora N, Lipsett JA (1985) Breast edema in patients treated conservatively for stage I and II breast cancer. Int J Radiat Oncol Biol Phys 11:1765–1768
Clarke D, Martinez A, Cox RS, Goffinet DR (1982) Breast edema following staging axillary node dissection in patients with breast carcinoma treated by radical radiotherapy. Cancer 49:2295–2299
Delay E, Gosset J, Toussoun G, Delaporte T, Delbaere M (2008) Post-treatment sequelae after breast cancer conservative surgery. Ann Chir Plast Esthét 53:135–152
Vuorela AL, Harju E, Jakobsson M (1989) Mammographic and palpation findings in the irradiated spared breast. Anticancer Res 9:1217–1222
Wratten CR, O’Brien PC, Hamilton CS, Bill D, Kilmurray J, Denham JW (2007) Breast edema in patients undergoing breast-conserving treatment for breast cancer: assessment via high frequency ultrasound. Breast J 13:266–273
Degnim AC, Miller J, Hoskin TL, Boughey JC, Loprinzi M, Thomsen K, Maloney S, Baddour LM, Cheville AL (2012) A prospective study of breast lymphedema-frequency, symptoms, and quality of life. Breast Cancer Res Treat 134:915–922
Kelemen G, Varga Z, Lázár G, Thurzó L, Kahán Z (2012) Cosmetic outcome 1–5 years after breast conservative surgery, irradiation and systemic therapy. Pathol Oncol Res 18:421–427
Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM (1995) Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 333:1456–1461
Dragun AE, Quillo AR, Riley EC, Roberts TL, Hunter AM, Rai SN, Callender GG, Jain D, Mcmasters KM, Spanos WJ (2013) Clinical investigation : breast cancer a Phase 2 trial of once-weekly hypofractionated breast irradiation : first report of acute toxicity, feasibility, and patient satisfaction. Int J Radiat Oncol Biol Phys 85:123–128
Formenti SC, Hsu H, Fenton-kerimian M, Roses D, Guth A, Jozsef G, Goldberg JD, Dewyngaert JK (2012) Prone accelerated partial breast irradiation after breast-conserving surgery : five-year results of 100 patients. Int J Radiat Oncol Biol Phys 84:606–611
Chadha M, Vongtama D, Friedmann P, Parris C, Boolbol SK, Woode R, Harrison LB (2012) Comparative acute toxicity from whole breast irradiation using 3-week accelerated schedule with concomitant boost and the 6.5-week conventional schedule with sequential boost for early-stage breast cancer. Clin Breast Cancer 12:57–62
Barnett GC, Wilkinson JS, Moody AM, Wilson CB, Twyman N, Wishart GC, Burnet NG, Coles CE (2011) The Cambridge Breast Intensity-modulated radiotherapy trial: patient- and treatment-related factors that influence late toxicity. Clin Oncol 23:662–673
Berrang TS, Olivotto I, Kim D-H, Nichol A, Cho BCJ, Mohamed IG, Parhar T, Wright JR, Truong P, Tyldesley S, Sussman J, Wai E, Whelan T (2011) Three-year outcomes of a Canadian multicenter study of accelerated partial breast irradiation using conformal radiation therapy. Int J Radiat Oncol Biol Phys 81:1220–1227
Kuzmiak CM, Zeng D, Cole E, Pisano ED (2009) Mammographic findings of partial breast irradiation. Acad Radiol 16:819–825
Constantine C, Parhar P, Lymberis S, Fenton-Kerimian M, Han SC, Rosenstein BS, Formenti SC (2008) Feasibility of accelerated whole-breast radiation in the treatment of patients with ductal carcinoma in situ of the breast. Clin Breast Cancer 8:269–274
Wenz F, Welzel G, Keller A, Blank E, Vorodi F, Herskind C, Tomé O, Sütterlin M, Kraus-Tiefenbacher M (2008) Early initiation of external beam radiotherapy (EBRT) may increase the risk of long-term toxicity in patients undergoing intraoperative radiotherapy (IORT) as a boost for breast cancer. Breast 17:617–622
Vicini FA, Chen P, Wallace M, Mitchell C, Hasan Y, Grills I, Kestin L, Schell S, Goldstein NS, Kunzman J, Gilbert S, Martinez A (2007) Interim cosmetic results and toxicity using 3D conformal external beam radiotherapy to deliver accelerated partial breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 69:1124–1130
Mussari S, Sabino della Sala W, Busana L, Vanoni V, Eccher C, Zani B, Menegotti L, Tomio L (2006) Full-dose intraoperative radiotherapy with electrons in breast cancer. First report on late toxicity and cosmetic results from a single-institution experience. Strahlenther Onkol 182:589–595
Marcenaro M, Sacco S, Pentimalli S, Berretta L, Andretta V, Grasso R, Parodi C, Guarrera M, Scarpati D (2004) Measures of late effects in conservative treatment of breast cancer with standard or hypofractionated radiotherapy. Tumori 90:586–591
Back M (2004) Impact of radiation therapy on acute toxicity in breast conservation therapy for early breast cancer. Clin Oncol 16:12–16
Hoeller U, Tribius S, Kuhlmey A, Grader K, Fehlauer F, Alberti W (2003) Increasing the rate of late toxicity by changing the score? A comparison of RTOG/EORTC and LENT/SOMA scores. Int J Radiat Oncol Biol Phys 55:1013–1018
Lamb D, Atkinson C, Joseph D, O’Brien P, Ackland S, Bonaventura A, Dady P, Hamilton C, Spry N, Stewart J, Denham J (1999) Simultaneous adjuvant radiotherapy and chemotherapy for stage I and II breast cancer. Australas Radiol 43:220–226
Grann A, McCormick B, Chabner ES, Gollamudi SV, Schupak KD, Mychalczak BR, Heerdt AS, Merchant TE, Hunt MA (2000) Prone breast radiotherapy in early-stage breast cancer: a preliminary analysis. Int J Radiat Oncol Biol Phys 47:319–325
Fung MC, Schultz DJ, Solin LJ (1997) Early-stage bilateral breast cancer treated with breast-conserving surgery and definitive irradiation the university of Pennsylvania experience. Int J Radiat Oncol Biol Phys 38:959–967
Kuptsova N, Chang-Claude J, Kropp S, Helmbold I, Schmezer P, von Fournier D, Haase W, Sautter-Bihl ML, Wenz F, Onel K, Ambrosone CB (2008) Genetic predictors of long-term toxicities after radiation therapy for breast cancer. Int J Cancer 122:1333–1339
Li F, He Z, Xue M, Chen L, Wu S, Guan X (2011) Feasibility and acute toxicity of 3-dimensional conformal external-beam accelerated partial-breast irradiation for early-stage breast cancer after breast-conserving surgery in Chinese female patients. Chin Med J 124:1305–1309
Mayo C, Lo YC, Fitzgerald TJ, Urie M (2004) Forward-planned, multiple-segment, tangential fields with concomitant boost in the treatment of breast cancer. Med Dosim 29:265–270
Goyal S, Daroui P, Khan AJ, Kearney T, Kirstein L, Haffty BG (2013) Three-year outcomes of a once daily fractionation scheme for accelerated partial breast irradiation (APBI) using 3-D conformal radiotherapy (3D-CRT). Cancer Med 2:964–971
Forrai G, Polgar C, Zana K, Riedl E, Fodor J, Nemeth G, Fornet B (2001) The role of STIR MRI sequence in the evaluation of the breast following conservative surgery and radiotherapy. Neoplasma 48:7–11
Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, Dobbs HJ, Hopwood P, Lawton PA, Magee BJ, Mills J, Simmons S, Sydenham MA, Venables K, Bliss M, Yarnold JR (2013) The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 14:1086–1094
Jahr S, Schoppe B, Reisshauer A (2008) Effect of treatment with low-intensity and extremely low-frequency electrostatic fields (Deep Oscillation) on breast tissue and pain in patients with secondary breast lymphoedema. J Rehabil Med 40:645–650
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Verbelen, H., Gebruers, N., Beyers, T. et al. Breast edema in breast cancer patients following breast-conserving surgery and radiotherapy: a systematic review. Breast Cancer Res Treat 147, 463–471 (2014). https://doi.org/10.1007/s10549-014-3110-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-014-3110-8