A Review of Treatment for Breast Cancer-Related Lymphedema: Paradigms for Clinical Practice.
*Bandages; Adult; Aged; Breast Neoplasms/*complications/pathology/*surgery; Cohort Studies; Combined Modality Therapy; Drainage/methods; Female; Humans; Lymphedema/etiology/physiopathology/*therapy; Massage/methods; Mastectomy/*adverse effects/methods; Middle Aged; Prognosis; Quality of Life; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survivors; Treatment Outcome
OBJECTIVES: Breast cancer-related lymphedema (BCRL) represents a major complication of breast cancer treatment, impacting the quality of life for breast cancer survivors that develop it. The purpose of this review is to evaluate the literature surrounding BCRL treatment modalities to guide clinicians regarding risk-stratified treatment options. METHODS: A review of studies over a 10-year period (January 2006 to February 2016) was performed. Noninvasive strategies evaluated included compression therapy, manual lymphatic drainage, and complex decongestive therapy (CDT). Invasive modalities evaluated included liposuction and lymphatic bypass/lymph node transfer (LNT). Our search yielded 149 initial results with 45 studies included. RESULTS: A number of prospective studies have found that CDT is associated with volume reduction in the affected limb as well as improved quality of life, particularly in patients with early stage BCRL. With regards to invasive treatment options, data support that lymphatic bypass and LNT are associated with symptomatic and physiologic improvements, particularly in patients with more advanced BCRL. In addition, a small number of studies suggest that liposuction may be an efficacious and safe treatment for moderate to severe BCRL. CONCLUSIONS: CDT is an effective treatment modality for early stage BCRL. For more advanced BCRL, LNT has demonstrated efficacy. Further study is required with respect to comparing BCRL treatment modalities.
Smile Timothy D; Tendulkar Rahul; Schwarz Graham; Arthur Douglas; Grobmyer Stephen; Valente Stephanie; Vicini Frank; Shah Chirag
American journal of clinical oncology
2018
2018-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/COC.0000000000000355" target="_blank" rel="noreferrer noopener">10.1097/COC.0000000000000355</a>
Regional Nodal Irradiation: Examining the Clinical Implications of Randomized Trials.
*Randomized Controlled Trials as Topic; Adjuvant/adverse effects/methods; Axilla; Breast Neoplasms/pathology/*radiotherapy; Disease-Free Survival; Female; Humans; Lymph Nodes/*pathology; Lymphatic Irradiation/adverse effects/*methods; Lymphedema/etiology; Mastectomy; Radiation Pneumonitis/etiology; Radiotherapy; Survival Rate
Shah Chirag; Khan Atif; Arthur Douglas; Wazer David; Mantz Constantine; Verma Vivek; Vicini Frank
American journal of clinical oncology
2016
2016-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/COC.0000000000000250" target="_blank" rel="noreferrer noopener">10.1097/COC.0000000000000250</a>
Minimizing toxicity in breast irradiation.
*Breast cancer; *Cancer Survivors; *IMRT; *partial breast irradiation; *radiation; *toxicity; Breast Neoplasms/*radiotherapy; Female; Humans; Quality of Life; Radiation Injuries/*prevention & control
Shah Chirag; Banda Bhanu; Chandra Rohit; Vicini Frank
Expert review of anticancer therapy
2017
2017-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/14737140.2017.1285231" target="_blank" rel="noreferrer noopener">10.1080/14737140.2017.1285231</a>
The Role of MRI in the Follow-up of Women Undergoing Breast-conserving Therapy.
*Magnetic Resonance Imaging; Aftercare; Breast Neoplasms/*diagnostic imaging/*surgery; Female; Humans; Local/*diagnostic imaging; Mammography; Mastectomy; Neoplasm Recurrence; Population Surveillance/*methods; Segmental
OBJECTIVES: Breast-conserving therapy (BCT) represents a standard of care in the management of breast cancer. However, unlike mastectomy, women treated with BCT require follow-up imaging of the treated breast as well as the contralateral breast as part of posttreatment surveillance. Traditionally, surveillance has consisted of clinical exams and mammograms. However, magnetic resonance imaging (MRI) has emerged as a breast imaging technique utilized as part of high-risk screening programs as well as part of the initial diagnosis and workup of women considered for BCT. At this time, the role of MRI as part of follow-up for women treated with BCT remains unclear. METHODS: A systematic review was performed to evaluate the role of MRI following BCT. RESULTS: Although there is no randomized evidence supporting the routine use of MRI in surveillance post-BCT, a review of the literature demonstrates that MRI (1) has increased sensitivity as compared with mammography to detect recurrences, and (2) can help evaluate mammographic abnormalities before biopsy and/or surgery. CONCLUSIONS: In patients with higher risk of local recurrence, surveillance with MRI may represent an effective surveillance strategy though subgroups benefiting have not been identified nor has the impact on quality of life and cost been evaluated.
Shah Chirag; Ahlawat Stuti; Khan Atif; Tendulkar Rahul D; Wazer David E; Shah Shilpi S; Vicini Frank
American journal of clinical oncology
2016
2016-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/COC.0000000000000290" target="_blank" rel="noreferrer noopener">10.1097/COC.0000000000000290</a>