Blichert-Toft M

Influence of Adjuvant Irradiation on the Development of Late Arm Lymphedema and Impaired Shoulder Mobility after Mastectomy for Carcinoma of the Breast

The influence of postoperative radiation therapy on development of late arm lymphedema and shoulder joint disability following mastectomy was evaluated from a series of 57 women with operable carcinoma of the breast. The patients were divided into three groups. Common for all three groups was mastectomy and partial axillary dissection. In addition one group received postoperative irradiation plus systemic therapy and another group systemic therapy alone. The incidence of late arm lymphedema/impaired shoulder mobility was 11%/4% in the group of patients undergoing surgery alone, 46%/38% in the group of patients receiving adjuvant irradiation and 6%/12% in the group of patients receiving adjuvant systemic therapy. It is concluded that adjuvant irradiation to the axilla in patients with metastatic lymph nodes highly increases the risk of late physical sequelae following modified radical mastectomy. Adjuvant systemic therapy can be administered to high risk patients without increasing the risk of late arm lymphedema and shoulder disability.

Influence of Adjuvant Irradiation on Shoulder Joint Function After Mastectomy for Breast Carcinoma

The influence of postoperative radiation therapy on ipsilateral shoulder function following mastectomy was evaluated from a series of 52 women with primarily operable carcinoma of the breast. Mastectomy and partial axillary dissection were carried out in all patients. In addition, 29 of the patients received postoperative irradiation with 36.6 Gy applied mid-axillarily in 12 fractions with irradiation twice a week. A significant impairment of the active shoulder mobility was found in the irradiated group (p less than 0.01). The passive mobility did not differ significantly between the two groups. The impairment of active shoulder mobility is suggested to be caused by radiation induced subcutaneous fibrosis.

Low-risk breast cancer patients treated by mastectomy and lower axillary dissection. The present status of the Danish Breast Cancer Cooperative Group Trial 77-A.

From 1977 to 1982 a total of 2,935 women with breast cancer fulfilled the criteria for inclusion in the low-risk protocol of the Danish Breast Cancer Cooperative Group, DBCG 77-A. The operation performed was a total mastectomy with axillary dissection slightly modified according to Cady. Postoperatively the patients were examined clinically and by chest radiography with intervals for ten years or until recurrence. With a median observation time of seven years loco-regional recurrence appeared in 409 patients (13.9%): chest wall 9.3%, axilla 3.7%. Half of the recurrences were diagnosed within two years postoperatively. Metastases appeared in 396 patients (13.5%), mainly in bones and lungs; 96 patients (23.5%) with loco-regional recurrence and 174 (43.9%) with distant metastases died from breast cancer during the observation time. Life-table analyses of recurrence-free survival (61.7%) and survival (75.4%) are presented. The results of the treatment are in accordance with reports in the literature, but a straightforward comparison is impossible on account of a huge variation in surgical and postsurgical treatment. Finally, the surgical technique in the participating departments in this nation-wide study was evaluated. A high grade of uniformity with respect to loco-regional recurrences was found.