Breast Cancer Research and Treatment

, Volume 21, Issue 2, pp 139–145 | Cite as

Comparison of pain, motion, and edema after modified radical mastectomy vs. local excision with axillary dissection and radiation

  • Lynn Gerber
  • Marsha Lampert
  • Carol Wood
  • Mary Duncan
  • Teresa D'Angelo
  • Wendy Schain
  • Harold McDonald
  • David Danforth
  • Peggie Findlay
  • Eli Glatstein
  • Marc E. Lippman
  • Seth M. Steinberg
  • Catherine Gorrell
  • Allen Lichter
  • Ernest Demoss
Report

Summary

Recent data suggest that prognosis is similar for women with primary breast cancer whether they receive modified radical mastectomy (MRM) or local excision and axillary dissection with radiation (XRT). The effects of either of these treatments on arm mobility, pain, or edema have not been compared. To assess the impact of MRM or XRT on mobility, pain, or edema, we evaluated patients treated in a prospective randomized trial designed to assess prognosis following MRM or XRT. All were provided a standardized physical therapy program including arm mobilization, shoulder strengthening, prevention and treatment of upper extremity edema, and education about arm function.

Patients were evaluated for chest wall pain, arm motion, muscle strength, and edema as determined by circumferential measurements at the wrist, forearm, and arm. Evaluations were performed preoperatively and at yearly anniversaries of their surgery. Women receiving XRT had more chest wall tenderness at 1 and 2 years after surgery than those receiving MRM (p2<0.0001 and p2=0.0007 respectively). Those receiving MRM were slower to reach their preoperative range of motion (ROM) (p2=0.043). Incidence of muscle weakness was similar in both groups. The few patients with local recurrence of tumor had more upper extremity edema than those who did not recur (p2=0.085) at 1 year and (p2=0.02) at 2 years. In patients who did not develop local recurrence, those who had received XRT had greater but nonsignificant increases in upper extremity circumferential measures compared with those receiving MRM at any anniversary evaluation.

Patients receiving MRM and XRT are likely to have some differences in functional outcome. These differences may be important to individuals and be significant in helping them choose between MRM and XRT based upon individual functional needs.

Key words

breast cancer conservation treatment local excision mastectomy radiotherapy rehabilitation surgery 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Halsted WS: The results of operations for the cure of cancer of the breast performed at Johns Hopkins Hospital from June, 1889 to January, 1894. Johns Hopkins Hosp Bull 4: 497–555Google Scholar
  2. 2.
    Urban JA, Baker HW: Radical mastectomy in continuity with an en bloc resection of the internal mammary lymph node chain. Cancer 5: 992–1008, 1952PubMedGoogle Scholar
  3. 3.
    Auchincloss H: Significance of location and number of axillary metastases in carcinoma of the breast: A justification for a conservative operation. Ann Surg 158: 37–46, 1963PubMedGoogle Scholar
  4. 4.
    Veronesi U, Sacozzi R, Del Vecchio M,et al.: Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med 305: 6–11, 1981PubMedGoogle Scholar
  5. 5.
    Fisher B, Bauer M, Margolese R,et al.: Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 312: 666–673, 1985Google Scholar
  6. 6.
    Lasry JM, Margolese RG, Poisson R, Shibata H, Fleischer D, Lafleur D, Legault S, Taillefer S: Depression and body image following mastectomy and lumpectomy. J Chron Dis 40: 529–534, 1987PubMedGoogle Scholar
  7. 7.
    Pollard K, Callum KG, Altman DG,et al.: Shoulder movement following mastectomy. Clin Oncol 2: 343–349, 1976PubMedGoogle Scholar
  8. 8.
    Atkins H, Hayward JL, Klugman DJ,et al.: Treatment of early breast cancer: A report after 10 years of a clinical trial. Br Med J 2: 423–429, 1972PubMedGoogle Scholar
  9. 9.
    Winick L, Robbins GF: The post mastectomy rehabilitation group program. Structure, procedure, and population demography. Am J Surg 132: 599–602, 1976PubMedGoogle Scholar
  10. 10.
    Lotze MT, Duncan MA, Gerber LH,et al.: Early vs. delayed shoulder motion following axillary dissection. Ann Surg 193: 288–295, 1981PubMedGoogle Scholar
  11. 11.
    Wood C, Gerber LH: Rehabilitation of the patient with breast cancer. In: Lippman ME, Danforth DN,et al. (eds) Diagnosis and Management of Breast Cancer. W.B. Saunders, Philadelphia, 1988, pp. 457–467Google Scholar

Copyright information

© Kluwer Academic Publishers 1992

Authors and Affiliations

  • Lynn Gerber
    • 1
  • Marsha Lampert
    • 1
  • Carol Wood
    • 1
  • Mary Duncan
    • 1
  • Teresa D'Angelo
    • 2
  • Wendy Schain
    • 5
  • Harold McDonald
    • 3
  • David Danforth
    • 3
  • Peggie Findlay
    • 2
  • Eli Glatstein
    • 2
  • Marc E. Lippman
    • 4
  • Seth M. Steinberg
    • 6
  • Catherine Gorrell
    • 2
  • Allen Lichter
    • 2
  • Ernest Demoss
    • 3
  1. 1.Department of Rehabilitation MedicineWarren Grant Magnuson Clinical Center, NIHUSA
  2. 2.Radiation Oncology Branch, NCIUSA
  3. 3.Surgical Branch, NCIUSA
  4. 4.Medicine Branch, NCIUSA
  5. 5.Consultant in Clinical CareWarren Grant Magnuson Clinical Center, NIHUSA
  6. 6.Biostatistics and Data Management Branch, NCIUSA

Personalised recommendations