Shoulder-arm morbidity in early breast cancer patients treated with two different radiation techniques

Background. Adjuvant radiation therapy (RT) after breast cancer surgery, especially to the axilla, is a risk factor for the development of shoulder-arm morbidity, but it reduces the risk of local recurrence by approximately 33% and increases survival rates. With the introduction of modern radiation technologies, long term irradiation sequelae have decreased. Hypofractionation shortens the treatment schedule and is an acceptable alternative to the conventional RT in terms of curation. TomoTherapy® lowers the delivered irradiation dose to vital organs. Minor changes in fractionation and dose distribution are associated with a large variation in the risk of developing shoulder-arm morbidity. Since hypofractionation delivers a bigger size of dose per fraction, a higher incidence of shoulder-arm morbidity could be expected. Objectives. The main objective is to determine whether the incidence of shoulder-arm morbidity in early breast cancer patients treated with hypofractionated RT with TomoTherapy® is higher than in patients treated with conventional post-surgery RT. Methods. Breast Cancer Related Lymphedema of the arm (BCRL), shoulder mobility and scapula positioning have been evaluated before the intervention and one to three months after finishing the intervention. Circumferential tape measurements have been performed to diagnose BCRL, through the ≥ 2 cm and ≥ 10% diagnostic criteria, together with self-reported subjective BCRL symptoms. Shoulder mobility has been assessed by a goniometer and scapula positioning has been determined by inspection, palpation and the lateral scapular slide test. Results. The principal results of 93 pts show that there is no significant difference (p < .05) in BCRL incidence, shoulder mobility impairment and altered scapula positioning between the control and the intervention group, before and after the intervention. Conclusions. Hypofractionated RT with TomoTherapy® does not cause higher BCRL incidence, impaired shoulder mobility and altered scapula positioning compared with conventional post-surgery RT, one to three months after finishing the RT.