Association Between Symptom Burden and Early Lymphatic Abnormalities After Regional Nodal Irradiation for Breast Cancer

Alison K Yoder; Tianlin Xu; Peter Youssef; Sarah DeSnyder; Kathryn E Marqueen; Lynn Isales; Ruitao Lin; Benjamin D Smith; Wendy A Woodward; Michael C Stauder; Eric A Strom; Melissa B Aldrich; Simona F Shaitelman

doi:10.1016/j.prro.2023.10.008

Association Between Symptom Burden and Early Lymphatic Abnormalities After Regional Nodal Irradiation for Breast Cancer

Pract Radiat Oncol. 2023 Oct 31:S1879-8500(23)00287-4. doi: 10.1016/j.prro.2023.10.008. Online ahead of print.

Authors

Affiliations

¹ Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
² Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
³ Morehouse School of Medicine, Atlanta, Georgia.
⁴ Departments of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
⁵ Departments of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
⁶ Center for Molecular Imaging, The Brown Foundation Institute for Molecular Medicine, University of Texas Health Science Center-Houston, Houston, Texas.
⁷ Departments of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: sfshaitelman@mdanderson.org.

PMID: 37914083
PMCID: PMC11058114 (available on 2025-04-30)
DOI: 10.1016/j.prro.2023.10.008

Abstract

Purpose: Dermal backflow visualized on near-infrared fluorescence lymphatic imaging (NIRF-LI) signals preclinical lymphedema that precedes the development of volumetrically defined lymphedema. We sought to evaluate whether dermal backflow correlates with patient-reported lymphedema outcomes (PRLO) surveys in breast cancer patients treated with regional nodal irradiation (RNI).

Methods and materials: Patients with breast cancer planned for axillary dissection and RNI prospectively underwent perometry, NIRF-LI, and PRLOs (the Lymphedema Symptom Intensity and Distress Survey [LSIDS] and QuickDASH) at baseline, after surgery, and at 6, 12, and 18 months after radiation. Clinical lymphedema was defined as an arm volume increase ≥5% over baseline. Trends over time were assessed using analysis of variance testing. The association between survey responses and both dermal backflow and lymphedema was assessed using a linear mixed-effects model.

Results: Sixty participants completed at least 2 sets of measurements and surveys and were eligible for analysis. Fifty-four percent of patients had cT3-T4 disease, 53% cN3 disease, and 75% had a body mass index >25. Dermal backflow and clinical lymphedema increased from 10% to 85% and from 0% to 40%, respectively, from baseline to 18 months. In the adjusted model, soft tissue sensation, neurologic sensation, and functional LSIDS subscale scores were associated with presence of dermal backflow (all P < .05). Both dermal backflow and lymphedema were associated with QuickDASH score (P < .05).

Conclusions: In this high-risk cohort, we found highly prevalent early signs of lymphedema, with increased symptom burden from baseline. Presence of dermal backflow correlated with PRLO measures, highlighting a potential NIRF-LI use to identify patients for early intervention trials after RNI.

Abstract

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