Abstract
Purpose
Immediate lymphatic reconstruction (ILR) is a procedure known to reduce the risk of lymphedema in patients undergoing axillary lymph node dissection (ALND). However, patients who receive adjuvant radiotherapy are at increased risk of lymphedema. The aim of this study was to quantify the extent of radiation at the site of surgical prevention.
Methods
We recently began deploying clips at the site of ILR to identify the site during radiation planning. A retrospective review was performed to identify breast cancer patients who underwent ILR with clip deployment and adjuvant radiation therapy from October 2020 to April 2022. Patients were excluded if they had not completed radiotherapy. The exposure and dose of radiation received by the site was determined and recorded.
Results
In a cohort of 11 patients, the site fell within the radiation field in 7 patients (64%) and received a median dose of 4280 cGy. Among these 7 patients, 3 had sites located within tissue considered at risk of oncologic recurrence and the remaining 4 sites received radiation from a tangential field treating the breast or chest wall. The median dose to the ILR site for the 4 patients whose sites were outside the radiation fields was 233 cGy.
Conclusion
Our findings suggest that even when the site of surgical prevention was not within the targeted radiation field during treatment planning, it remains susceptible to radiation. Strategies for limiting radiation at this site are needed.
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Data Availability
The datasets generated during and/or analyzed during the current study are not publicly available due containment of protected health information but are available from the corresponding author on reasonable request.
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Acknowledgements and Funding Information
Research reported in this publication was supported in part by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number R01HL157991 (D.S.), the National Institutes of Health Common Fund under award number U54HL165440 (D.S.), and the 2022 JOBST Lymphatic Research Grant awarded by the Boston Lymphatic Symposium, Inc. (received by author R.F.).
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Rosie Friedman, JacqueLyn Kinney, Daphna Spiegel, Julia Willcox, Abraham Recht, and Dhruv Singhal. The first draft of the manuscript was written by Rosie Friedman and Daphna Spiegel, and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript.
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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Beth Israel Deaconess Medical Center Institutional Review Board, Protocol #2022P000234.
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Friedman, R., Spiegel, D.Y., Kinney, J. et al. Quantifying radiation in the axillary bed at the site of lymphedema surgical prevention. Breast Cancer Res Treat 201, 299–305 (2023). https://doi.org/10.1007/s10549-023-06988-y
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DOI: https://doi.org/10.1007/s10549-023-06988-y