Factors affecting the formation of lymphedema due to breast cancer (Is primary systemic treatment an independent factor in the formation of breast cancer related lymphedema?).

Abstract

Objective: This study aimed to evaluate the local and systemic risk factors associated with breast cancer-related lymphedema (BCRL), with a focus on whether primary systemic treatment (PST), particularly taxane-based chemotherapy, is an independent risk factor.

Material and methods: A prospective clinical study was conducted on 80 breast cancer patients discussed at our institution's weekly breast cancer council. Patients were grouped based on PST status. Clinical examinations and measurements were performed preoperatively and postoperatively at 1, 6, 12, 18, and 24 months. Only the operated arm was assessed using tape measurements and the truncated cone formula. Arm volumes were calculated, and lymphedema (LE) was diagnosed based on a volume difference (≥200 mL or ≥2 cm circumference).

Results: No statistically significant differences were found between PST and non-PST groups regarding age, body mass index, menopausal status, smoking, or tumor characteristics. LE was detected in 7 (8.8%) patients, all Stage 1. PST and taxane-based chemotherapy were not significantly associated with LE development. However, seroma presence (p=0.038) and axillary radiotherapy (p=0.043) were significantly associated with LE. Arm volume increase was most significant at 1 and 18 months postoperatively (p=0.055 and p=0.044, respectively).

Conclusion: PST, including taxane-based chemotherapy, does not appear to be an independent risk factor for BCRL. In contrast, postoperative seroma and axillary radiotherapy are significantly associated with LE development. Early identification and management strategies should target these modifiable factors to reduce the risk of LE.