Full axillary lymph node dissection and increased breast epidermal thickness 1 year after radiation therapy for breast cancer

• Type of Material: Article
• Authors: Jolinta Lin, Emory University; Xiaofeng Yang, Emory University; Monica Serra, Emory University; Andrew Miller, Emory University; Karen Godette, Emory University; Shannon Kahn, Emory University; Simone Henry, Emory University; Gabrielle Brown, Emory University; Tian Liu, Emory University; Mylin Torres, Emory University
• Language: English
• Date: 2019-12-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 John Wiley & Sons, Inc. All rights reserved
• Final Published Version (URL): http://dx.doi.org/10.1002/jso.25757
• Title of Journal or Parent Work: Journal of Surgical Oncology
• Volume: 120
• Issue: 8
• Start Page: 1397
• End Page: 1403
• Grant/Funding Information: A seed grant also provided by the Radiation Therapy Oncology Group Community Clinical Oncology and Symptom Management Group.; Funding was also provided by the Fred Cooper Family Foundation Breast Cancer Initiative and Robbins Scholar Award from the Winship Cancer Institute of Emory University. Elements of this study were presented at the ASTRO 2017 Annual Meeting in San Diego, CA.; This study was supported by National Institutes of Health (NIH), National Cancer Institute (NCI) grants R21 CA155511, R03CA173770, R03CA183006, and P30CA138292.
• Keywords: radiation therapy; Radiotherapy; Fibrosis; lymph node dissection; Oncology; skin thickening; breast cancer; Randomized trial; Surgery; Multicenter; Skin toxicity; Life Sciences & Biomedicine; Science & Technology; Irradation; toxicity; Follow up
• Research Categories: Health Sciences, Rehabilitation and Therapy; Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

Background: We previously reported a prospective study showing axillary lymph node dissection (ALND) is associated with increased breast skin thickening during and 6 weeks post-radiation therapy (RT), and now report ALND’s long-term impact at 1 year. Methods: Among 66 women who received whole breast RT after lumpectomy, objective ultrasound measurements of epidermal thickness over four quadrants of the treated breast were measured at five time points: before RT, week 6 of RT, and 6 weeks, 6 months, and 1 year post-RT. Skin thickness ratio (STRA) was generated by normalizing for corresponding measurements of the contralateral breast. Results: A total of 2,436 ultrasound images were obtained. Among 63 women with evaluable data at 1 year, mean STRA significantly increased at 6 months (absolute mean increase of 65%, SD 0.054), and remained elevated at 1 year post-RT (absolute mean increase of 44%, SD 0.048). In multivariable analysis, ALND compared to sentinel lymph node biopsy, longer interval between surgery and RT, increased baseline STRA, and Caucasian race predicted for more severe changes in STRA at 1 year compared to baseline (all P < .05). Conclusions: In the setting of whole breast RT, our findings suggest that ALND has long-term repercussions on breast skin thickening.