乳腺癌患者放射治疗后上肢并发症的初步分析
|
摘要
目的：了解乳腺癌患者放射治疗后上肢淋巴水肿和肩关节功能障碍的发病情况，并分析上肢淋巴水肿发生相关的危险因素。
方法：回顾分析了92例在我科接受术后辅助放疗的乳腺癌患者临床资料，并对其上肢并发症的情况进行主观症状及客观体征两方面评估，上肢淋巴水肿的主观症状采用FCAT-B+4量表评估，而客观体征采用对双侧手臂肩峰端下15cm和尺骨鹰嘴下15cm处进行周径测量的方法，肩关节功能障碍的主观症状评价患者日常生活活动能力，而客观体征测量肩关节活动度，计算在两种方法下上肢并发症的发病率，并用单因素方差分析及Logistic回归分析上肢淋巴水肿发生的危险因素。
结果：上肢淋巴水肿发病率在主观症状及客观体征检查中分别为53.3%和32.6%，肩关节活动障碍发病率分别为57.6%和65.2%，其中客观体征检查发现锁骨上区照射组和未照射组上肢淋巴水肿发病率分别为37.8%和11.1%（P=0.03），腋窝淋巴结阳性组和腋窝淋巴结阴性组上肢淋巴水肿发病率分别为41.5%和11.1（P=0.005），术后分期为Ⅲ期组和早于Ⅲ期组上肢淋巴水肿发病率分别为52.5%和17.3%（P=0），多因素分析结果表明术后分期是上肢淋巴水肿的独立危险因素。
结论：上肢并发症是乳腺癌患者术后加放射治疗后常见并发症，发病率较高，锁骨上区照射、腋窝淋巴结阳性及术后分期较晚是上肢淋巴水肿的可能危险因素，尽可能减少正常组织受照以降低发病率，应予以重视。
Objective: To identify the probability of breast cancer-related arm lymphedema(BCRL) and impairments of shoulder function induced by radiotherapy in patients afterbreast cancer surgery and to analyze the relative risk factors contributing to development ofBCRL.
Methods: A total of92patients with breast cancer were treated with lumpectomy ormodified radical mastectomy and afterwards conformal radiotherapy in our hospital. Thedetermination of upper-body morbidity was based on subjective symptoms felt by patientsand objective signs viewed. FCAT-B+4scoring system was introduced to commentpatients’ symptoms and circumference measurement was taken at15cm below theacromion process and15cm below the olecranon in both arms, impairments of shoulderfunction is assessed along with self reports of activities of daily living and range ofmotion.Then the actuarial rates of upper-body morbidity were determined.Univariateanalysis was performed by Chi-Square test, and multivariable analysis was undertaken bybinary logistic regression.
Results: The actuarial rate of complains and signs of BCRL was respectively53.3%and32.6%, while being57.6%and65.2%in impairments of shoulder function. BCRL wasmore likely to develop in patients with advanced nodal status(41.5%vs.11.1%, P=0.005),patients with stage Ⅲ(52.5%vs.17.3%, P=0), and patients receiving supraclavicularirradiation (37.8%vs.11.1%, P=0.03). Stage is the independent risk factor leading tolymphedema after multivariable analysis.
Conclusions: These results suggest that upper-body morbidity is the commoncomplication with high morbidity induced by postoperative radiotherapy. The risk factors of BCRL include advanced nodal status, late stage and supraclavicular irradiation,whichmay raise BCRL, which emphasizes the importance of further efforts to reduce the dose ofnormal tissue.
方法：回顾分析了92例在我科接受术后辅助放疗的乳腺癌患者临床资料，并对其上肢并发症的情况进行主观症状及客观体征两方面评估，上肢淋巴水肿的主观症状采用FCAT-B+4量表评估，而客观体征采用对双侧手臂肩峰端下15cm和尺骨鹰嘴下15cm处进行周径测量的方法，肩关节功能障碍的主观症状评价患者日常生活活动能力，而客观体征测量肩关节活动度，计算在两种方法下上肢并发症的发病率，并用单因素方差分析及Logistic回归分析上肢淋巴水肿发生的危险因素。
结果：上肢淋巴水肿发病率在主观症状及客观体征检查中分别为53.3%和32.6%，肩关节活动障碍发病率分别为57.6%和65.2%，其中客观体征检查发现锁骨上区照射组和未照射组上肢淋巴水肿发病率分别为37.8%和11.1%（P=0.03），腋窝淋巴结阳性组和腋窝淋巴结阴性组上肢淋巴水肿发病率分别为41.5%和11.1（P=0.005），术后分期为Ⅲ期组和早于Ⅲ期组上肢淋巴水肿发病率分别为52.5%和17.3%（P=0），多因素分析结果表明术后分期是上肢淋巴水肿的独立危险因素。
结论：上肢并发症是乳腺癌患者术后加放射治疗后常见并发症，发病率较高，锁骨上区照射、腋窝淋巴结阳性及术后分期较晚是上肢淋巴水肿的可能危险因素，尽可能减少正常组织受照以降低发病率，应予以重视。
Objective: To identify the probability of breast cancer-related arm lymphedema(BCRL) and impairments of shoulder function induced by radiotherapy in patients afterbreast cancer surgery and to analyze the relative risk factors contributing to development ofBCRL.
Methods: A total of92patients with breast cancer were treated with lumpectomy ormodified radical mastectomy and afterwards conformal radiotherapy in our hospital. Thedetermination of upper-body morbidity was based on subjective symptoms felt by patientsand objective signs viewed. FCAT-B+4scoring system was introduced to commentpatients’ symptoms and circumference measurement was taken at15cm below theacromion process and15cm below the olecranon in both arms, impairments of shoulderfunction is assessed along with self reports of activities of daily living and range ofmotion.Then the actuarial rates of upper-body morbidity were determined.Univariateanalysis was performed by Chi-Square test, and multivariable analysis was undertaken bybinary logistic regression.
Results: The actuarial rate of complains and signs of BCRL was respectively53.3%and32.6%, while being57.6%and65.2%in impairments of shoulder function. BCRL wasmore likely to develop in patients with advanced nodal status(41.5%vs.11.1%, P=0.005),patients with stage Ⅲ(52.5%vs.17.3%, P=0), and patients receiving supraclavicularirradiation (37.8%vs.11.1%, P=0.03). Stage is the independent risk factor leading tolymphedema after multivariable analysis.
Conclusions: These results suggest that upper-body morbidity is the commoncomplication with high morbidity induced by postoperative radiotherapy. The risk factors of BCRL include advanced nodal status, late stage and supraclavicular irradiation,whichmay raise BCRL, which emphasizes the importance of further efforts to reduce the dose ofnormal tissue.
引文
[1]Jemal A, Barry F, Ferlay J, et al. Cancer statistics. CA Cancer J Clin,2011;61:69-90.
[2]郑荣寿,张思维,陈万青,等.中国肿瘤登记地区2008年肿瘤发病和死亡资料分析.中国肿瘤,2012；21(1)：1-12.
[3]Coleman MP, Forman D, Bryant H, Butler J, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK,1995-2007(the International Cancer Benchmarking Partnership):an analysis of population-based cancer registry data. Lancet,2011;377(9760):127-38.
[4]Hayes SC, Johansson K, Stout NL, et al. Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care. Cancer,2012;118(8):2237-2249.
[5]Shah C, Vicini FA. Breast cancer-related arm lymphedema:incidence rates, diagnostic techniques, optimal management and risk reduction strategies. Int J Radiat Oncol Biol Phys,2011;81(4):907-914.
[6]Erickson VS, Pearson ML, Ganz PA, et al. Arm edema in breast cancer patients. Journal of national cancer institute,2001;93(2):96-111.
[7]Sandra C Hayes, Sheree Rye, Diana Battistutta,et al. Upper-body morbidity following breast cancer treatment is common, may persist longer-term and adversely influences quality of life. Health Qual Life Outcomes,2010;8:92.
[8]Shah C, Arthur D, Riutta J, et al. Breast-cancer related lymphedema:a review of procedure-specific incidence rates, clinical assessment aids, treatment paradigms, and risk reduction. The Breast Journal,2012;18(4):357-361.
[9]Shih YC, Xu Y, Cormier JN, et al. Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age:a2-year follow-up study. J Clin Oncol,2009;27(12):2007-2014.
[10]Rockson S. Bioimpedance analysis in the assessment of lymphoedema diagnosis and management. J Lymphoedema,2007;2(1):44-48.
[11]Coen JJ, Taghian AG, Kachnic LA, et al. Risk of lymphedema after regional nodal irradiation with breast conservation therapy. Int J Radiat Oncol Biol Phys,2003;55(5):1209-1215.
[12]Hayes SB, Freedman GM, Li T, et al. Does axillary boost increase lymphedema compared with supraclavicular alone after breast conservation? Int J Radiat Oncol Biol Phys,2008;72(5):1449-1455.
[13]季永领,田野,陆雪官,等.乳腺癌根治术加放射治疗后上肢并发症的临床分析.中华放射肿瘤学杂志,2004；13(3)：201-204.
[14]Meeske KA, Sullivan-Halley J, Smith AW, et al. Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women. Breast Cancer Res Treat,2009;113(2):383-391.
[15]NCCN clinical practice guidelines in oncology breast cancer. version1.2012.
[16]Coster S, Poole K, Fallowfield LJ, et al. The validation of a quality of life scale to assess the impact of arm morbidity in breast cancer patients post-operatively. Breast Cancer Research and Treatment,2001;68(3):273-282.
[17]Deutsch M, Land S, Begovic M, et al. The incidence of arm edema in women with breast cancer randomized on the National Surgical Adjuvant Breast and Bowel Project Study B-04to radical mastectomy versus total mastectomy and radio-therapy versus total mastectomy alone. Int J Radiat Oncol Biol Phys,2008;70(4):1020-1024.
[18]Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res,1987Jan;(214):160-164.
[19]Modi S, Stanton AW, Svensson WE, et al. Human lymphatic pumping measured in healthy and lym-phoedematous arms by lymphatic congestion lymphoscintigraphy. J Physiol,2007;583(1):271-285.
[20]Stout NL, Pfalzer LA, Levy E, et al. Segmental limb volume change as a predictor of the onset of lymphedema in women with early breast cancer.PM R,2011;3(12):1098-
[21]Hayes S, Cornish B, Newman B. Comparison of methods to diagnose lymphoedemaamong breast cancer survivors:6-month follow-up. Breast Cancer Res Treat,2005;89(3):221-6.
[22]McLaughlin SA, Wright MJ, Morris KT,et al. Prevalence of Lymphedema in WomenWith Breast Cancer5Years After Sentinel Lymph Node Biopsy or Axillary Dissection:Objective Measurements. J Clin Oncol,2008,26(32):5213-5219.
[23]G rtner R, Jensen MB, Kronborg L, et al. Self-reported arm-lymphedema andfunctional impairment after breast cancer treatment-A nationwide study of prevalenceand associated factors. Breast,2010;19(6):506-515.
[24]Khan F, Amatya B, Pallant JF, et al. Factors associated with long-term functionaloutcomes and psychological sequelae in women af ter breast cancer. Breast,2012;21(3):314-320.
[25]Ashikaga T, Krag DN, Land SR, et al. Morbidity results from the NSABP-32trialcomparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol,2010;102(2):111-118.
[26]Hayes SC, Janda M, Cornish B, et al. Lymphoedema following breast cancer:incidence, risk factors and effect on upper body function. J Clin Oncol,2008;26(21):3536-3542.
[27]Mak SS, Mo KF, Suen JJ, et al. Lymphedema and quality of life in Chinese womenafter treatment for breast cancer. Eur J Oncol Nurs,2009;13(2):110-115.
[28]Shah C, Wilkinson JB, Baschnagel A,et al. Factors associated with the development ofbreast cancer-related lymphedema after whole-breast irradiation. Int J Radiat OncolBiol Phys,2012;83(4):1095-1100.
[29]Kwan ML, Darbinian J, Schmitz KH, et al. Risk Factors of Lymphedema in aProspective Breast Cancer Survivorship Study: The Pathways Study. Arch Surg,2010;145(11):1055-1063.
[30]Bar Ad V, Cheville A, Solin LJ,et al. Time course of mild arm lymphedema after breastconservation treatment for early-stage breast cancer. Int J Radiat Oncol Biol Phys,2010;76(1):85-90.
[31]Lucci A, McCall LM, Beitsch PD,et al. American College of Surgeons OncologyGroup. Surgical complications associated with sentinel lymph node dissection (SLND)plus axillary lymph node dissection compared with SLND alone in the AmericanCollege of Surgeons Oncology Group Trial Z0011. J Clin Oncol,2007;25(24):3657-3763.
[32]Shaw C, Mortimer P, Judd PA, et al. A randomized controlled trial of weight reductionas a treatment for breast cancer-related lymphedema. Cancer,2007;110(8):1868–1874.
[33]Ozcinar B, Guler SA, Kocaman N,et al. Breast cancer related lymphedema in patientswith different loco-regional treatments. Breast,2012;21(3):361-365.
[34]Purushotham AD, Klevesath MB, Chou P, et al. Lymph Node Status and BreastCancer-related Lymphedema. Ann Surg,2007;246(1):42-45.
[35]Lundstedt D, Gustafsson M, Steineck G, et al. Long-term symptoms after radiotherapyof supraclavicular lymph nodes in breast cancer patients. Radiotherapy and Oncology,2012;103(2):155-160.
[36]Yu JI, Park W, Hun SJ, et al. Determining which patients require irradiation of thesupraclavicular nodal area after surgery for N1breast cancer. Int J Radiat Oncol BiolPhys,2010;78(4):1135-1141.
[37]Petrek JA, Senie RT, Peters M,et al. Lymphedema in a cohort of breast carcinomasurvivors20years after diagnosis. Cancer,2001;92(6):1368-1377.
[38]Newman B, Lose F, Kedda MA,et al. Possible Genetic Predisposition to Lymphedemaafter Breast Cancer. Lymphatic Research and Biology,2012;10(1):2-13.
[1] Jemal A, Barry F, Ferlay J, et al. Cancer statistics. CA Cancer J Clin,2011;61:69-90.
[2] Shah C, Arthur D, Riutta J,et al. Breast-cancer related lymphedema: a review ofprocedure-specific incidence rates, clinical assessment AIDS, treatment paradigms,and risk reduction. Breast J,2012;18(4):357-361.
[3] G rtner R, Jensen MB, Kronborg L, et al. Self-reported arm-lymphedema andfunctional impairment after breast cancer treatment-A nationwide study ofprevalence and associated Factors. Breast,2010;19(6):506-515.
[4] Shah C, Vicini FA. Breast cancer-related arm lymphedema: incidence rates,diagnostic techniques, optimal management and risk reduction strategies. Int JRadiat Oncol Biol Phys,2011;81(4):907-914.
[5] G rtner R, Jensen MB, Nielsen J, et al. Prevalence of and factors associated withpersistent pain following breast cancer surgery. JAMA,2009;302(18):1985-1992.
[6] Tobin MB, Lacey HJ, Meyer L, et al. The psychological morbidity of breast cancer-related arm swelling. Phychological morbidity of lymphoedema. Cancer,1993;72(11):3248-3252.
[7] Ashikaga T, Krag DN, Land SR, et al. Morbidity results from the NSABP-32trialcomparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol,2010;102:111-118.
[8] Lucci A, McCall LM, Beitsch PD, et al. American College of Surgeons OncologyGroup Surgical complications associated with sentinel lymph node dissection(SLND) plus axillary lymph node dissection compared with SLND alone in theAmerican College of Surgeons Oncology Group Trial Z0011. J Clin Oncol,2007;25(24):3657-3763.
[9] Coen JJ, Taghian AG, Kachnic LA, et al. Risk of lymphedema after regional nodalirradiation with breast conservation therapy. Int J Radiat Oncol Biol Phys,2003;55(5):1209-1215.
[10] Hayes SB, Freedman GM, Li T, et al. Does axillary boost increase lymphedemacompared with supraclavicular alone after breast conservation? Int J Radiat OncolBiol Phys,2008;72(5):1449-1455.
[11] Norman SA, Localio AR, Kallan MJ, et al. Risk factors for lymphedema for breastcancer treatment. Cancer Epidemiol Biomarkers Prev,2010;19(11):2734-2746.
[12] Hayes SC, Johansson K, Stout NL, et al. Upper-body morbidity after breast cancer:incidence and evidence for evaluation, prevention, and management within aprospective surveillance model of care. Cancer,2012;118(8):2237-2249.
[13] Clark B, Sitzia J, Harlow W. Incidence and risk of arm oedema following treatmentfor breast cancer: a three-year follow-up study. Q J Med,2005;98(5):343-348.
[14] Hayes SC, Janda M, Cornish B, Battistutta D, et al. Lymphedema following breastcancer: incidence, risk factors and effect on upper body function. J Clin Oncol,2008;26(21):3536-3542.
[15] Norman S, Localio A, Potashnik S, et al. Lymphedema in breast cancer survivors:incidence, degree, time course, treatment, and symptoms. J Clin Oncol,2009;27:390-397.
[16] Clough-Gorr KM, Ganz PA, Silliman RA. Older breast cancer survivors:factorsassociated with self-reported symptoms of persistent lymphedema over7years offollow-up. Breast J,2010;16(2):147-155.
[17] Deutsch M, Land S, Begovic M, et al. The incidence of arm edema in women withbreast cancer randomized on the National Surgical Adjuvant Breast and BowelProject Study B-04to radical mastectomy versus total mastectomy and radiotherapyversus total mastectomy alone. Int J Radiat Oncol Biol Phys,2008;70(4):1020-1024.
[18] Shaw C, Mortimer P, Judd PA, et al. A randomized controlled trial of weightreduction as a treatment for breast cancer-related lymphedema. Cancer,2007;110(8):1868-1874.
[19] Shah C, Wilkinson JB, Baschnagel A, et al. Factors associated with thedevelopment of breast cancer-related lymphedema after whole-breast irradiation.Int J Radiat Oncol Biol Phys,2012;83(4):1095-1100.
[20] Meeske KA, Sullivan-Halley J, Smith AW, et al. Risk factors for arm lymphedemafollowing breast cancer diagnosis in Black women and White women. BreastCancer Res Treat,2009;113(2):383-391.
[21] Purushotham AD, Klevesath MB, Chou P, et al. Lymph Node Status and BreastCancer-related Lymphedema. Ann Surg,2007;246(1):42-45.
[22] Erickson VS, Pearson ML, Ganz PA, et al. Arm edema in breast cancer patients.Journal of national cancer institute,2001;93(2):96-111.
[23] Stanton AW, Modi S, Mellor RH, et al. Recent advances in breast cancer-relatedlymphedema of the arm: lymphatic pump failure and predisposing factors. LymphatRes Biol,2009;7(1):29-45.
[24] Modi S, Stanton AW, et al. Human lymphatic pumping measured in healthy andlymphoedematous arms by lymphatic congestion lymphoscintigraphy. J Physiol,2007;583(1):271-285.
[25] Bates DO. An interstitial hypothesis for breast cancer related lymphedema.Pathophysiology,2010;17(4):289-294.
[26] Pavy JJ, Denekamp J, Letschert J, et al. Late effects toxicity scoring: The SOMAscale. Int J Radiat Oncol Biol Phys,1995;31:1043-1047.
[27] National Institutes of Health. Common Terminology Criteria for Adverse Events,2010. Available from: http://evs.nci.nih. gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf.
[28] Norman SA, Miller LT, Erikson HB, et al. Development and validation of atelephone questionnaire to characterize lymphedema in women treated for breastcancer. Phys Ther,2001;81(6):1192-1205.
[29] Armer JM, Radina ME, Porock D, et al. Predicting breast cancer-relatedlymphedema using self-reported symptoms. Nurs Res,2003;52(6):370-379.
[30] Klernas P, Kristjanson LJ, Johansson K. Assessment of quality of life inlymphedema patients: validity and reliability of the Swedish version of theLymphedema Quality of Life Inventory (LQOLI). Lymphology,2010;43(3):135-145.
[31] Brady M, Cella D, Mo F, et al. Reliability and validity of the FunctionalAssessment of Cancer Therapy-Breast (FACT-B) quality of life instrument. J ClinOncol,1997;15(3):974-986.
[32] Sprangers MA, Groenvold M, Arraras JI, et al. The European Organization forResearch and Treatment of Cancer breast cancer-specific quality-of-lifequestionnaire module: first results from a three-country field study. J Clin Oncol,1996;14(10):2756-2768.
[33] Hayes SC, Rye S, Battistutta D, et al. Prevalence of upper-body symptomsfollowing breast cancer and its relationship with upper-body function andlymphedema. Lymphology,2010;43(4):178-187.
[34] Acukiewicz M, Russell TA, Otoole J, et al. A Standardized Method forQuantification of Developing Lymphedema in Patients Treated for Breast Cancer.Int J Radiat Oncol Biol Phys,2012;79(5):1436-1443.
[35] Rockson S. Bioimpedance analysis in the assessment of lymphoedema diagnosisand management. J Lymphoedema,2007;2(1):44-48.
[36] Czerniec SA, Ward LC, Refshauge KM, et al. Assessment of breast cancer-relatedarm lymphedema-comparison of physical measurement methods and self-report.Cancer Invest,2010;28(1):54-62.
[37] Chen YW, Tsai HJ, Hung HC, et al. Reliability study of measurements forlymphedema in breast cancer patients. Am J Phys Med Rehabil,2008;87(1):33-38.
[38] Czerniec SA, Ward LC, Refshauge KM, et al. Assessment of breast cancer-relatedarm lymphedema comparison of physical measurement methods and self-report.Cancer Invest,2010;28(1):54-62.
[39] Foroughi N, Dylke ES, Paterson RD, et al. Inter-rater reliability of armcircumference measurement. Lymphat Res Biol,2011;9(2):101-107.
[40] Taylor R, Jayasinghe UW, Keolmeyer L, et al. Reliability and Validity of ArmVolume Measurements for Assessment of Lymphedema. Phys ther,2006;86(2):205-214.
[41] Smoot BJ, Wong JF, Dodd MJ. Comparison of Diagnostic Accuracy of ClinicalMeasures of Breast Cancer-Related Lymphedema: Area Under the Curve. ArchPhys Med Rehabil,2011;92(4):603-610.
[42] Sagen A, Karesen R, Skaane P, et al. Validity for the simplified water displacementinstrument to measure arm lymphedema as a result of breast cancer surgery. ArchPhys Med Rehabil,2009;90(5):803-809.
[43] Gjorup C, Zerahn B, Hendel HW. Assessment of volume measurement of breastcancer-related lymphedema by three methods: Circumference measurement, waterdisplacement, and dual energy x-ray absorptiometry. Lymphat Res Biol,2010;8(2):111-119.
[44] Vignes S, Porcher R, Arrault M, et al. Long term management of breast cancer-related lymphedema after intensive decongestive physiotherapy. Breast Cancer ResTreat,2007;101(3):285-290.
[45] Kim do S, Sim YJ, Jeong HJ, et al. Effective of active resistance exercise on breastcancer-related lymphedema: A randomized controlled trial. Arch Phys Med Rehabil,2010;91(12):1844-1848.
[46] Brorson H, Ohlin K, Olsson G, et al. Quality of life following liposuction andconservative treatment of arm lymphedema. Lymphology,2006;39(1):8-25.
[47] Damstra RJ, Voesten HG, van Schelven WD, et al. Lymphatic venous anastomosis(LVA) for treatment of secondary arm lymphedema. A prospective study of11LVAprocedures in10patients with breast cancer related lymphedema and a criticalreview of the literature. Breast Cancer Res Treat,2009;113(2):199-206.
[48] Casley-Smith JR, Morgan RG, Piller NB. Treatment of lymphedema of the armsand legs with5,6-Benzo-a-pyrone. New Engl J Med,1993;329(6):1158-1163.
[49] Micke O, Bruns F, Mucke R, et al. Selenium in the treatment of radiation-associatedsecondary lymphedema. Int J Radiat Oncol Biol Phys,2003;56(1):40-49.
[50] Magnusson M, Hoglund P, Johansson K, et al. Pentoxifylline and vitamin Etreatment for prevention of radiation-induced side-effects in women with breastcancer: a phase two, double-blind, placebo-controlled randomised clinical trial(Ptx-5). Eur J Cancer,2009;45(14):2488-2495.
[51] Stout Gergich NL, Pfalzer LA, McGarvey C, et al. Preoperative assessment enablesthe early diagnosis and successful treatment of lymphedema. Cancer,2008;112(12):2809-2819.
[52] Johansson K, Branje E. Arm lymphoedema in a cohort of breast cancer survivors10years after diagnosis. Acta Oncol,2010;49(2):166-173.
[53] Stout NL, Andrews K, Binkley JM, et al. Prospective surveillance model forrehabilitation for women with breast cancer. Cancer,2012;118(8):2191-2200.
[2]郑荣寿,张思维,陈万青,等.中国肿瘤登记地区2008年肿瘤发病和死亡资料分析.中国肿瘤,2012；21(1)：1-12.
[3]Coleman MP, Forman D, Bryant H, Butler J, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK,1995-2007(the International Cancer Benchmarking Partnership):an analysis of population-based cancer registry data. Lancet,2011;377(9760):127-38.
[4]Hayes SC, Johansson K, Stout NL, et al. Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care. Cancer,2012;118(8):2237-2249.
[5]Shah C, Vicini FA. Breast cancer-related arm lymphedema:incidence rates, diagnostic techniques, optimal management and risk reduction strategies. Int J Radiat Oncol Biol Phys,2011;81(4):907-914.
[6]Erickson VS, Pearson ML, Ganz PA, et al. Arm edema in breast cancer patients. Journal of national cancer institute,2001;93(2):96-111.
[7]Sandra C Hayes, Sheree Rye, Diana Battistutta,et al. Upper-body morbidity following breast cancer treatment is common, may persist longer-term and adversely influences quality of life. Health Qual Life Outcomes,2010;8:92.
[8]Shah C, Arthur D, Riutta J, et al. Breast-cancer related lymphedema:a review of procedure-specific incidence rates, clinical assessment aids, treatment paradigms, and risk reduction. The Breast Journal,2012;18(4):357-361.
[9]Shih YC, Xu Y, Cormier JN, et al. Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age:a2-year follow-up study. J Clin Oncol,2009;27(12):2007-2014.
[10]Rockson S. Bioimpedance analysis in the assessment of lymphoedema diagnosis and management. J Lymphoedema,2007;2(1):44-48.
[11]Coen JJ, Taghian AG, Kachnic LA, et al. Risk of lymphedema after regional nodal irradiation with breast conservation therapy. Int J Radiat Oncol Biol Phys,2003;55(5):1209-1215.
[12]Hayes SB, Freedman GM, Li T, et al. Does axillary boost increase lymphedema compared with supraclavicular alone after breast conservation? Int J Radiat Oncol Biol Phys,2008;72(5):1449-1455.
[13]季永领,田野,陆雪官,等.乳腺癌根治术加放射治疗后上肢并发症的临床分析.中华放射肿瘤学杂志,2004；13(3)：201-204.
[14]Meeske KA, Sullivan-Halley J, Smith AW, et al. Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women. Breast Cancer Res Treat,2009;113(2):383-391.
[15]NCCN clinical practice guidelines in oncology breast cancer. version1.2012.
[16]Coster S, Poole K, Fallowfield LJ, et al. The validation of a quality of life scale to assess the impact of arm morbidity in breast cancer patients post-operatively. Breast Cancer Research and Treatment,2001;68(3):273-282.
[17]Deutsch M, Land S, Begovic M, et al. The incidence of arm edema in women with breast cancer randomized on the National Surgical Adjuvant Breast and Bowel Project Study B-04to radical mastectomy versus total mastectomy and radio-therapy versus total mastectomy alone. Int J Radiat Oncol Biol Phys,2008;70(4):1020-1024.
[18]Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res,1987Jan;(214):160-164.
[19]Modi S, Stanton AW, Svensson WE, et al. Human lymphatic pumping measured in healthy and lym-phoedematous arms by lymphatic congestion lymphoscintigraphy. J Physiol,2007;583(1):271-285.
[20]Stout NL, Pfalzer LA, Levy E, et al. Segmental limb volume change as a predictor of the onset of lymphedema in women with early breast cancer.PM R,2011;3(12):1098-
[21]Hayes S, Cornish B, Newman B. Comparison of methods to diagnose lymphoedemaamong breast cancer survivors:6-month follow-up. Breast Cancer Res Treat,2005;89(3):221-6.
[22]McLaughlin SA, Wright MJ, Morris KT,et al. Prevalence of Lymphedema in WomenWith Breast Cancer5Years After Sentinel Lymph Node Biopsy or Axillary Dissection:Objective Measurements. J Clin Oncol,2008,26(32):5213-5219.
[23]G rtner R, Jensen MB, Kronborg L, et al. Self-reported arm-lymphedema andfunctional impairment after breast cancer treatment-A nationwide study of prevalenceand associated factors. Breast,2010;19(6):506-515.
[24]Khan F, Amatya B, Pallant JF, et al. Factors associated with long-term functionaloutcomes and psychological sequelae in women af ter breast cancer. Breast,2012;21(3):314-320.
[25]Ashikaga T, Krag DN, Land SR, et al. Morbidity results from the NSABP-32trialcomparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol,2010;102(2):111-118.
[26]Hayes SC, Janda M, Cornish B, et al. Lymphoedema following breast cancer:incidence, risk factors and effect on upper body function. J Clin Oncol,2008;26(21):3536-3542.
[27]Mak SS, Mo KF, Suen JJ, et al. Lymphedema and quality of life in Chinese womenafter treatment for breast cancer. Eur J Oncol Nurs,2009;13(2):110-115.
[28]Shah C, Wilkinson JB, Baschnagel A,et al. Factors associated with the development ofbreast cancer-related lymphedema after whole-breast irradiation. Int J Radiat OncolBiol Phys,2012;83(4):1095-1100.
[29]Kwan ML, Darbinian J, Schmitz KH, et al. Risk Factors of Lymphedema in aProspective Breast Cancer Survivorship Study: The Pathways Study. Arch Surg,2010;145(11):1055-1063.
[30]Bar Ad V, Cheville A, Solin LJ,et al. Time course of mild arm lymphedema after breastconservation treatment for early-stage breast cancer. Int J Radiat Oncol Biol Phys,2010;76(1):85-90.
[31]Lucci A, McCall LM, Beitsch PD,et al. American College of Surgeons OncologyGroup. Surgical complications associated with sentinel lymph node dissection (SLND)plus axillary lymph node dissection compared with SLND alone in the AmericanCollege of Surgeons Oncology Group Trial Z0011. J Clin Oncol,2007;25(24):3657-3763.
[32]Shaw C, Mortimer P, Judd PA, et al. A randomized controlled trial of weight reductionas a treatment for breast cancer-related lymphedema. Cancer,2007;110(8):1868–1874.
[33]Ozcinar B, Guler SA, Kocaman N,et al. Breast cancer related lymphedema in patientswith different loco-regional treatments. Breast,2012;21(3):361-365.
[34]Purushotham AD, Klevesath MB, Chou P, et al. Lymph Node Status and BreastCancer-related Lymphedema. Ann Surg,2007;246(1):42-45.
[35]Lundstedt D, Gustafsson M, Steineck G, et al. Long-term symptoms after radiotherapyof supraclavicular lymph nodes in breast cancer patients. Radiotherapy and Oncology,2012;103(2):155-160.
[36]Yu JI, Park W, Hun SJ, et al. Determining which patients require irradiation of thesupraclavicular nodal area after surgery for N1breast cancer. Int J Radiat Oncol BiolPhys,2010;78(4):1135-1141.
[37]Petrek JA, Senie RT, Peters M,et al. Lymphedema in a cohort of breast carcinomasurvivors20years after diagnosis. Cancer,2001;92(6):1368-1377.
[38]Newman B, Lose F, Kedda MA,et al. Possible Genetic Predisposition to Lymphedemaafter Breast Cancer. Lymphatic Research and Biology,2012;10(1):2-13.
[1] Jemal A, Barry F, Ferlay J, et al. Cancer statistics. CA Cancer J Clin,2011;61:69-90.
[2] Shah C, Arthur D, Riutta J,et al. Breast-cancer related lymphedema: a review ofprocedure-specific incidence rates, clinical assessment AIDS, treatment paradigms,and risk reduction. Breast J,2012;18(4):357-361.
[3] G rtner R, Jensen MB, Kronborg L, et al. Self-reported arm-lymphedema andfunctional impairment after breast cancer treatment-A nationwide study ofprevalence and associated Factors. Breast,2010;19(6):506-515.
[4] Shah C, Vicini FA. Breast cancer-related arm lymphedema: incidence rates,diagnostic techniques, optimal management and risk reduction strategies. Int JRadiat Oncol Biol Phys,2011;81(4):907-914.
[5] G rtner R, Jensen MB, Nielsen J, et al. Prevalence of and factors associated withpersistent pain following breast cancer surgery. JAMA,2009;302(18):1985-1992.
[6] Tobin MB, Lacey HJ, Meyer L, et al. The psychological morbidity of breast cancer-related arm swelling. Phychological morbidity of lymphoedema. Cancer,1993;72(11):3248-3252.
[7] Ashikaga T, Krag DN, Land SR, et al. Morbidity results from the NSABP-32trialcomparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol,2010;102:111-118.
[8] Lucci A, McCall LM, Beitsch PD, et al. American College of Surgeons OncologyGroup Surgical complications associated with sentinel lymph node dissection(SLND) plus axillary lymph node dissection compared with SLND alone in theAmerican College of Surgeons Oncology Group Trial Z0011. J Clin Oncol,2007;25(24):3657-3763.
[9] Coen JJ, Taghian AG, Kachnic LA, et al. Risk of lymphedema after regional nodalirradiation with breast conservation therapy. Int J Radiat Oncol Biol Phys,2003;55(5):1209-1215.
[10] Hayes SB, Freedman GM, Li T, et al. Does axillary boost increase lymphedemacompared with supraclavicular alone after breast conservation? Int J Radiat OncolBiol Phys,2008;72(5):1449-1455.
[11] Norman SA, Localio AR, Kallan MJ, et al. Risk factors for lymphedema for breastcancer treatment. Cancer Epidemiol Biomarkers Prev,2010;19(11):2734-2746.
[12] Hayes SC, Johansson K, Stout NL, et al. Upper-body morbidity after breast cancer:incidence and evidence for evaluation, prevention, and management within aprospective surveillance model of care. Cancer,2012;118(8):2237-2249.
[13] Clark B, Sitzia J, Harlow W. Incidence and risk of arm oedema following treatmentfor breast cancer: a three-year follow-up study. Q J Med,2005;98(5):343-348.
[14] Hayes SC, Janda M, Cornish B, Battistutta D, et al. Lymphedema following breastcancer: incidence, risk factors and effect on upper body function. J Clin Oncol,2008;26(21):3536-3542.
[15] Norman S, Localio A, Potashnik S, et al. Lymphedema in breast cancer survivors:incidence, degree, time course, treatment, and symptoms. J Clin Oncol,2009;27:390-397.
[16] Clough-Gorr KM, Ganz PA, Silliman RA. Older breast cancer survivors:factorsassociated with self-reported symptoms of persistent lymphedema over7years offollow-up. Breast J,2010;16(2):147-155.
[17] Deutsch M, Land S, Begovic M, et al. The incidence of arm edema in women withbreast cancer randomized on the National Surgical Adjuvant Breast and BowelProject Study B-04to radical mastectomy versus total mastectomy and radiotherapyversus total mastectomy alone. Int J Radiat Oncol Biol Phys,2008;70(4):1020-1024.
[18] Shaw C, Mortimer P, Judd PA, et al. A randomized controlled trial of weightreduction as a treatment for breast cancer-related lymphedema. Cancer,2007;110(8):1868-1874.
[19] Shah C, Wilkinson JB, Baschnagel A, et al. Factors associated with thedevelopment of breast cancer-related lymphedema after whole-breast irradiation.Int J Radiat Oncol Biol Phys,2012;83(4):1095-1100.
[20] Meeske KA, Sullivan-Halley J, Smith AW, et al. Risk factors for arm lymphedemafollowing breast cancer diagnosis in Black women and White women. BreastCancer Res Treat,2009;113(2):383-391.
[21] Purushotham AD, Klevesath MB, Chou P, et al. Lymph Node Status and BreastCancer-related Lymphedema. Ann Surg,2007;246(1):42-45.
[22] Erickson VS, Pearson ML, Ganz PA, et al. Arm edema in breast cancer patients.Journal of national cancer institute,2001;93(2):96-111.
[23] Stanton AW, Modi S, Mellor RH, et al. Recent advances in breast cancer-relatedlymphedema of the arm: lymphatic pump failure and predisposing factors. LymphatRes Biol,2009;7(1):29-45.
[24] Modi S, Stanton AW, et al. Human lymphatic pumping measured in healthy andlymphoedematous arms by lymphatic congestion lymphoscintigraphy. J Physiol,2007;583(1):271-285.
[25] Bates DO. An interstitial hypothesis for breast cancer related lymphedema.Pathophysiology,2010;17(4):289-294.
[26] Pavy JJ, Denekamp J, Letschert J, et al. Late effects toxicity scoring: The SOMAscale. Int J Radiat Oncol Biol Phys,1995;31:1043-1047.
[27] National Institutes of Health. Common Terminology Criteria for Adverse Events,2010. Available from: http://evs.nci.nih. gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf.
[28] Norman SA, Miller LT, Erikson HB, et al. Development and validation of atelephone questionnaire to characterize lymphedema in women treated for breastcancer. Phys Ther,2001;81(6):1192-1205.
[29] Armer JM, Radina ME, Porock D, et al. Predicting breast cancer-relatedlymphedema using self-reported symptoms. Nurs Res,2003;52(6):370-379.
[30] Klernas P, Kristjanson LJ, Johansson K. Assessment of quality of life inlymphedema patients: validity and reliability of the Swedish version of theLymphedema Quality of Life Inventory (LQOLI). Lymphology,2010;43(3):135-145.
[31] Brady M, Cella D, Mo F, et al. Reliability and validity of the FunctionalAssessment of Cancer Therapy-Breast (FACT-B) quality of life instrument. J ClinOncol,1997;15(3):974-986.
[32] Sprangers MA, Groenvold M, Arraras JI, et al. The European Organization forResearch and Treatment of Cancer breast cancer-specific quality-of-lifequestionnaire module: first results from a three-country field study. J Clin Oncol,1996;14(10):2756-2768.
[33] Hayes SC, Rye S, Battistutta D, et al. Prevalence of upper-body symptomsfollowing breast cancer and its relationship with upper-body function andlymphedema. Lymphology,2010;43(4):178-187.
[34] Acukiewicz M, Russell TA, Otoole J, et al. A Standardized Method forQuantification of Developing Lymphedema in Patients Treated for Breast Cancer.Int J Radiat Oncol Biol Phys,2012;79(5):1436-1443.
[35] Rockson S. Bioimpedance analysis in the assessment of lymphoedema diagnosisand management. J Lymphoedema,2007;2(1):44-48.
[36] Czerniec SA, Ward LC, Refshauge KM, et al. Assessment of breast cancer-relatedarm lymphedema-comparison of physical measurement methods and self-report.Cancer Invest,2010;28(1):54-62.
[37] Chen YW, Tsai HJ, Hung HC, et al. Reliability study of measurements forlymphedema in breast cancer patients. Am J Phys Med Rehabil,2008;87(1):33-38.
[38] Czerniec SA, Ward LC, Refshauge KM, et al. Assessment of breast cancer-relatedarm lymphedema comparison of physical measurement methods and self-report.Cancer Invest,2010;28(1):54-62.
[39] Foroughi N, Dylke ES, Paterson RD, et al. Inter-rater reliability of armcircumference measurement. Lymphat Res Biol,2011;9(2):101-107.
[40] Taylor R, Jayasinghe UW, Keolmeyer L, et al. Reliability and Validity of ArmVolume Measurements for Assessment of Lymphedema. Phys ther,2006;86(2):205-214.
[41] Smoot BJ, Wong JF, Dodd MJ. Comparison of Diagnostic Accuracy of ClinicalMeasures of Breast Cancer-Related Lymphedema: Area Under the Curve. ArchPhys Med Rehabil,2011;92(4):603-610.
[42] Sagen A, Karesen R, Skaane P, et al. Validity for the simplified water displacementinstrument to measure arm lymphedema as a result of breast cancer surgery. ArchPhys Med Rehabil,2009;90(5):803-809.
[43] Gjorup C, Zerahn B, Hendel HW. Assessment of volume measurement of breastcancer-related lymphedema by three methods: Circumference measurement, waterdisplacement, and dual energy x-ray absorptiometry. Lymphat Res Biol,2010;8(2):111-119.
[44] Vignes S, Porcher R, Arrault M, et al. Long term management of breast cancer-related lymphedema after intensive decongestive physiotherapy. Breast Cancer ResTreat,2007;101(3):285-290.
[45] Kim do S, Sim YJ, Jeong HJ, et al. Effective of active resistance exercise on breastcancer-related lymphedema: A randomized controlled trial. Arch Phys Med Rehabil,2010;91(12):1844-1848.
[46] Brorson H, Ohlin K, Olsson G, et al. Quality of life following liposuction andconservative treatment of arm lymphedema. Lymphology,2006;39(1):8-25.
[47] Damstra RJ, Voesten HG, van Schelven WD, et al. Lymphatic venous anastomosis(LVA) for treatment of secondary arm lymphedema. A prospective study of11LVAprocedures in10patients with breast cancer related lymphedema and a criticalreview of the literature. Breast Cancer Res Treat,2009;113(2):199-206.
[48] Casley-Smith JR, Morgan RG, Piller NB. Treatment of lymphedema of the armsand legs with5,6-Benzo-a-pyrone. New Engl J Med,1993;329(6):1158-1163.
[49] Micke O, Bruns F, Mucke R, et al. Selenium in the treatment of radiation-associatedsecondary lymphedema. Int J Radiat Oncol Biol Phys,2003;56(1):40-49.
[50] Magnusson M, Hoglund P, Johansson K, et al. Pentoxifylline and vitamin Etreatment for prevention of radiation-induced side-effects in women with breastcancer: a phase two, double-blind, placebo-controlled randomised clinical trial(Ptx-5). Eur J Cancer,2009;45(14):2488-2495.
[51] Stout Gergich NL, Pfalzer LA, McGarvey C, et al. Preoperative assessment enablesthe early diagnosis and successful treatment of lymphedema. Cancer,2008;112(12):2809-2819.
[52] Johansson K, Branje E. Arm lymphoedema in a cohort of breast cancer survivors10years after diagnosis. Acta Oncol,2010;49(2):166-173.
[53] Stout NL, Andrews K, Binkley JM, et al. Prospective surveillance model forrehabilitation for women with breast cancer. Cancer,2012;118(8):2191-2200.