Adjuvant Chemotherapy Does Not Significantly Increase Breast Cancer-Related Lymphedema Risk

Amanda W. Jung, MPH

Adjuvant chemotherapy, including taxane-based chemotherapy, was not associated with a significant increase in risk of breast-cancer related lymphedema (BCRL), according to a poster presentation from the 2022 San Antonio Breast Cancer Symposium.¹

At a median follow-up of 58 months, a total of 141 patients (8%) out of an evaluable 1759 developed BCRL. The median time between surgery and BRCL development was 21 months. Factors determined to contribute to a significant increase in BCRL risk were age (65 years or older at the time of diagnosis; P < .001) and having a body mass index (BMI) equal to or greater than 30 (P = .005).

Compared with no chemotherapy treatment, neither taxane-based chemotherapies (P = .97) nor nontaxane based chemotherapies (P = .58) showed significant differences in BCRL risk. In addition, there were no significant differences in BCRL risk between taxane and nontaxane based therapies (P = .55).

Axillary lymph node dissection (ALND) with or without regional lymph node radiation (RLNR) was found to yield a significant increase in risk of BCRL compared with no nodal surgery (P < .001).

“[These] findings will improve patient education on BCRL risk for those receiving adjuvant chemotherapy, specifically for taxane-based chemotherapy,” Amanda W. Jung, MPH, of the Lymphedema Research Program in the Department of Radiation Oncology at Massachusetts General Hospital, and coinvestigators, wrote in the poster.

Taxane-based chemotherapies are commonly associated with fluid retention in the extremities, which may raise the risk of BCRL for patients. However, evidence surrounding the impact of adjuvant chemotherapy and taxane-based chemotherapy on BCRL are often inhibited by methodological flaws, according to the study authors. Therefore, they sought to determine if adjuvant chemotherapy represented an independent risk factor of BCRL. Additionally, investigators assessed whether taxane-based chemotherapies showed a significant difference in elevating the risk of this toxicity.

The study screened patients being treated for breast cancer using perometry to measure their overall limb volume at a preoperative baseline.^1,2 Patients needed to have had their arm measurements obtained at diagnosis of metastatic disease and before their bilateral breast cancer surgery. If obtained later than these time points, they could not be included. In addition, patients who had received neoadjuvant chemotherapy were not included.¹

Investigators defined BCRL as a relative volume change of 10% or greater between their measurements before surgery and their measurement 3 months following surgery. A cox regression model was used to estimate adjusted hazard ratios. Findings were adjusted for baseline BMI, ALND, RLNR, age at time of diagnosis, and smoking history.

Of the 1759 patients included in the analysis, 506 (29%) were 65 years or older. These patients accounted for 26% (n = 27) of the adjuvant nontaxane chemotherapy cohort (n = 104), 15% (n = 84) of the taxane-based cohort (n = 564), and 36% (n = 395) of the no chemotherapy cohort (n = 1091).

A total of 503 study participants overall (29%) had a BMI greater than 30, including 20 patients (19%) in the nontaxane chemotherapy group, 158 patients (28%) in the taxane-based chemotherapy group, and 325 patients (30%) in the no chemotherapy group.

In the total population, 93 patients who underwent both ALND and RLNR (5.3%), this included 3 patients (2.9%) in the nontaxane group, 5 patients (0.9%) in the taxane-based group, and 85 patients (7.8%) in the no chemotherapy group. Additionally, the percentage of patients who received ALND without RLNR was 11% (n = 201), including 11% (n = 11), 29% (n = 166), and 2.2% (n = 24) of the taxane, nontaxane, and no chemotherapy groups, respectively.

“Receipt of adjuvant chemotherapy and specifically adjuvant taxane-based chemotherapy were not associated with increased risk of BCRL,” study authors concluded. “ALND, RLNR, and high baseline BMI remained independent risk factors for BCRL.”

References

1. Jung AW, Juel BC, Smith LS, et al. The impact of adjuvant chemotherapy, including taxanes, on breast cancer-related lymphedema risk. Presented at 2022 San Antonio Breast Cancer Symposium; December 6-10, 2022; San Antonio, TX. Abstract P1-12-05.

2. Dylke ES, Ward LC, Kilbreath SL. Standardized approach to lymphedema screening. Oncologist. 2013;18(11):1242. doi:10.1634/theoncologist.2013-0238