The effect of paclitaxel treatment on the occurence of lymphedema of the arm in unilateral breast cancer patients with axillary lymph node dissection: A prospective study

Background Secondary lymphoedema of the ipsilateral arm (LEarm) is the most important chronic complication after dissection of the axillary lymph nodes (AD). Incidence rates for LEarm range from 5% to 56% within two years after surgery. (Lacomba et al., 2010) Compared to other formulated risk factors, the influence of chemotherapy on the development of LEarm has not yet been studied. Objective To define the possible causal relationship between paclitaxel treatment and the occurence of LEarm in breast cancer (BC) patients (pts) after unilateral breast surgery with AD. Design A prospective observational population based study. Setting Universitary hospital in Jette, Brussels, Belgium. Participants 52 early, unilateral, lymph node positive female BC pts, treated with breast surgery and AD. Intervention The intervention group was treated with post operative adjuvant concomitant irradiation and anthracyclines, 4∗FEC(500/75/600mg/m2), followed by paclitaxel, 12∗weekly (80mg/m2). The control group received the adjuvant concomitant irradiation and anthracyclines, 4∗FEC(500/75/600mg/m2), only. Main outcome measure Incidence of clinically significant LEarm (> 1,5 cm increase in arm circumference measured at two adjacent points compared with the non-affected arm). Measurements were conducted via tape measure during a follow up of two years post diagnosis. Results 40% of the 52 pts developed an LEarm, of which 80% was developed early during the adjuvant therapy with paclitaxel (intervention group). An incidence of 13% LEarm was found retrospectively in the control arm. Conclusion This study suggests the potential causal relationship between the previous concomitant chemo-irradiation and LEarm, through capillary leakage. This is the first prospective analysis of the incidence of LEarm in early BC pts treated with concomitant postoperative irradiation and anthracyclines followed by taxanes. The same research group is now further investigating whether and how the onset of LEarm during this treatment can be monitored, prevented and treated.