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

• 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
• Journal Title: Journal of Surgical Oncology
• Volume: Volume 120, Number 8
• Publisher: Wiley | 2019-12-01, Pages 1397-1403
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1002/jso.25757
• Subjects: Health Sciences, Oncology; Health Sciences, Medicine and Surgery; Health Sciences, Rehabilitation and Therapy
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Surgery; breast cancer; lymph node dissection; radiation therapy; skin thickening; toxicity; Randomized trial; Follow up; Skin toxicity; Radiotherapy; Irradation; Fibrosis; Surgery; Multicenter

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.