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William J. Gradishar, MD, FACP, FASCO
William J. Gradishar, MD, FACP, FASCO
Posted: Friday, October 25, 2024
A phase II clinical trial (HeNRIetta) showed the absolute rates of lymphedema remained low and predominantly grade 1 for patients with breast cancer who were treated with hypofractionated nodal regional irradiation. Additionally, Alfredo Urdaneta, MD, of Virginia Commonwealth University Health System, Richmond, and colleagues observed that the risk of lymphedema is not a reason to avoid moderate hypofractionated regional nodal irradiation. These findings were presented at the 2024 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 101).
The study included women with node-positive breast cancer who underwent definitive surgical resection. Eligible breast surgeries included lumpectomy (58.2%), mastectomy without breast reconstruction (20%), or mastectomy with breast reconstruction (19.4%); also included was nodal staging by sentinel lymph node (SLN) or axillary lymph node (ALN) dissection. Patients received breast and regional nodal irradiation at 42.56 Gy in 16 daily fractions.
The primary endpoint was the rate of lymphedema at 3 years after regional nodal irradiation for two cohorts: SLN (cohort A) and ALN (cohort B). Rates of lymphedema for cohorts A and B were estimated at 6% and 10%, respectively. The secondary objectives included 5-year oncologic outcomes, grade 3 or higher toxicities, cosmesis, and patient-reported outcomes.
A total of 134 women were enrolled in the study. Of them, 84 underwent SLN alone, and 50 completed ALN dissection between September 2015 and July 2021. The mean age was 58.1 years for cohort A and 62.5 years for cohort B. Lymphedema was observed in 11 patients (13.1%) with SLN alone (P = .5897) and in 9 patients (18%) who underwent ALN dissection (P = .65971). Two patients developed grade 2 lymphedema (limiting instrumental activities of daily living), and no grade 3 lymphedema (limiting self-care activities of daily living) was observed. At 36-month follow-up, 85.5% of treated with lumpectomy and 75.9% treated with mastectomy and breast reconstruction reportedly had excellent or good cosmesis.
Disclosure: Dr. Urdaneta reported no conflicts of interest.
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