Abstract P1-09-13: Risk of breast cancer related lymphedema after treatment with taxane-based chemotherapy: A prospective cohort study
Authors: Swaroop Meyha N , Miller Cynthia L , Horick Nora , Ferguson Chantal M , Skolny Melissa N , O'Toole Jean , Jammallo Lauren S , Specht Michelle C , Taghian Alphonse G 
Published: May 2015

Background: Taxane-based chemotherapy is routinely used in the treatment of breast cancer and has been shown to improve both disease-free survival (DFS) and overall survival (OS). A common side effect of taxane-based chemotherapy is fluid retention in the extremities, which may increase the risk of breast cancer related lymphedema (BCRL). BCRL is a chronic swelling of the arms, breast, or trunk due to accumulation of lymphatic fluid in the interstitial tissues, which has a profoundly negative impact on quality of life. Little data exists regarding the impact of taxane-based chemotherapy and fluid retention on risk of developing BCRL. We sought to determine whether receipt of taxane-based chemotherapy for the treatment of breast cancer increases the risk of BCRL development in a large, prospective cohort of breast cancer patients.

Methods: We identified 569 patients diagnosed with unilateral breast cancer between 2005-2012 who underwent surgery and prospective screening for BCRL at our institution. All patients included in this analysis had ≥ 18 months of post-operative follow-up. Bilateral arm volume measurements were performed using a perometer preoperatively and every 3-7 months postoperatively. BCRL was defined as a relative volume change (RVC) of ≥10%. Clinicopathologic characteristics and treatment details were obtained by medical record review. Cox proportional hazard analyses were performed to analyze risk of BCRL. Arm measurements obtained after contralateral prophylactic surgery or diagnosis of metastasis were excluded to avoid potential confounding.

Results: Arm volume measurements from 569 patients were included with a median post-operative follow-up of 28 months (range 18-75.1). 33% (187/569) of patients received taxane-based chemotherapy in the neoadjuvant and/or adjuvant setting, and 92% (172/187) of these patients received pre-medication with dexamethasone to prevent hypersensitivity and reduce edema. 3% (18/569) received non-taxane based chemotherapy and 64% (364/569) received no chemotherapy. 23% (131/569) had axillary lymph node dissection (ALND), 61% (346/569) had sentinel lymph node biopsy (SLNB), and 16% (92/569) had no nodal surgery. At 24 months, the cumulative incidence of BCRL was 5.0% (95% CI: 3.15-7.81%) among patients who did not receive taxane-based chemotherapy, compared to 13.4% (95% CI: 9.17-19.4%) in the taxane-based chemotherapy group. On univariate analysis, taxane-based chemotherapy was associated with increased risk of BCRL (HR=2.2, p=0.0037), in addition to ALND, higher body mass index, greater number of lymph nodes (LNs) dissected and greater number of positive LNs (p&lt;0.05 for all). However, taxane-based chemotherapy was not associated with increased BCRL risk on multivariate analysis (HR= 0.78, p=0.43), in which only ALND (HR=4.9, p&lt;0.0001) and number of positive LNs (HR=1.1, p=0.02) remained significant.

Conclusion: Our results suggest that patients who receive taxane-based chemotherapy are not at an increased risk of BCRL compared with patients who received non-taxane or no chemotherapy. This data can be used to improve patient education and counsel those who experience temporary fluid retention while on taxane-based chemotherapy.

Citation Format: Meyha N Swaroop, Cynthia L Miller, Nora Horick, Chantal M Ferguson, Melissa N Skolny, Jean O'Toole, Lauren S Jammallo, Michelle C Specht, Alphonse G Taghian. Risk of breast cancer related lymphedema after treatment with taxane-based chemotherapy: A prospective cohort study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-13.