Long-term symptoms after radiotherapy of supraclavicular lymph nodes in breast cancer patients

Lundstedt, Dan; Gustafsson, Magnus; Steineck, Gunnar; Alsadius, David; Sundberg, Agnetha; Wilderäng, Ulrica; Holmberg, Erik; Johansson, Karl-Axel; Karlsson, Per

doi:10.1016/j.radonc.2011.12.017

« Previous Next »Radiotherapy & Oncology
Volume 103, Issue 2 , Pages 155-160, May 2012

Long-term symptoms after radiotherapy of supraclavicular lymph nodes in breast cancer patients

Dan Lundstedt
- Department of Oncology, University of Gothenburg, Sweden
- Division of Clinical Cancer Epidemiology, Department of Oncology, University of Gothenburg, Sweden
- Corresponding author at: Department of Oncology, Regional Cancer Centre West, Kapellgången 9, 413 45 Gothenburg, Sweden.
Magnus Gustafsson
- Department of Oncology, University of Gothenburg, Sweden
- Division of Clinical Cancer Epidemiology, Department of Oncology, University of Gothenburg, Sweden
- Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
Gunnar Steineck
- Department of Oncology, University of Gothenburg, Sweden
- Division of Clinical Cancer Epidemiology, Department of Oncology, University of Gothenburg, Sweden
- Division of Clinical Cancer Epidemiology, Karolinska Institute, Stockholm, Sweden
David Alsadius
- Department of Oncology, University of Gothenburg, Sweden
- Division of Clinical Cancer Epidemiology, Department of Oncology, University of Gothenburg, Sweden
Agnetha Sundberg
- Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
Ulrica Wilderäng
- Department of Oncology, University of Gothenburg, Sweden
- Division of Clinical Cancer Epidemiology, Department of Oncology, University of Gothenburg, Sweden
Erik Holmberg
- Regional Cancer Centre West, Sahlgrenska University Hospital, Gothenburg, Sweden
Karl-Axel Johansson
- Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
Per Karlsson
- Department of Oncology, University of Gothenburg, Sweden

Received 14 July 2011; received in revised form 12 December 2011; accepted 19 December 2011. published online 10 February 2012.

Abstract

Background and purpose

Irradiation of the supraclavicular lymph nodes has historically increased the risk of brachial plexopathy. We report long-term symptoms after modern radiotherapy (based on 3D dose planning) in breast cancer patients with or without irradiation of the supraclavicular lymph nodes.

Material and methods

We collected information from 814 women consecutively treated with adjuvant radiotherapy for breast cancer. The women had breast surgery with axillary dissection (AD) or sentinel node biopsy (SNB). The breast area was treated to 50Gy in 2.0Gy fractions. Women with >three lymph node metastases had regional radiotherapy (RRT) to the supraclavicular lymph nodes. Three to eight years after radiotherapy, they received a questionnaire asking about paraesthesia, oedema, pain, and strength in the upper limb.

Results

Paraesthesia was reported by 38/192 (20%) after AD with RRT compared to 68/505 (13%) after AD without RRT (relative risk [RR] 1.47; 95% confidence interval [CI] 1.02–2.11) and by 9/112 (8%) after SNB without RRT (RR 2.46; 95% CI 1.24–4.90). Corresponding risks adjusted for oedema (RR 1.28; 95% CI 0.93–1.76) and (RR 1.75; 95% CI 0.90–3.39). In women ⩽49years with AD and RRT, 27% reported paraesthesia. No significant pain or decreased strength was reported after RRT.

Conclusion

Radiotherapy to the supraclavicular lymph nodes after axillary dissection increases the occurrence of paraesthesia, mainly among younger women. When adjusted for oedema the contribution from radiotherapy is no longer formally statistically significant indicating that there is also an indirect effect mediated by the oedema.

Keywords: Radiotherapy, Breast cancer, Supraclavicular lymph nodes, Long-term symptoms