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Breast cancer-related lymphedema(BCRL)is one of the most common complications after multidiscipline treatment of breast cancer,which manifests as upper limb swelling and skin changes and significantly affects limb function and quality of life.The occurrence and development of BCRL are affected by many factors including surgery,radiotherapy,drugs,infection,trauma,and so on.Therefore,it is important to identify the potential risk factors to establish individualized prevention strategies.Evidence-based risk assessment models for BCRL could help clinicians to identify high-risk patients and apply prospective surveillance to treat BCRL at early stage.For patients with advanced lymphedema,conservative treatment and surgical treatment could be delivered to relieve symptoms and improve their conditions.This article comprehensively reviewed the risk factors,prospective surveillance,intervention,and research progress of BCRL,to provide reference for multidisciplinary collaboration as well as clinical diagnosis and treatment in this field.
RESUMEN
Objective:To observe the long-term efficacy and late adverse reactions of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for mediastinal lymph node recurrence after radical surgery for esophageal squamous cell carcinoma (ESCC).Methods:A total of 20 ESCC patients with mediastinal lymph node recurrence (≤5) after radical surgery admitted to Department of Radiotherapy, Shanghai Ruijin Hospital between June 2019 and December 2021 were enrolled in this prospective study. Among them, 10 patients were enrolled in phase I study and 10 patients in phase II study. Four, 3 and 13 patients received three different doses of SIB-IMRT at 58.8 Gy/28 fractions, 64.4 Gy/28 fractions and 70.0 Gy/28 fractions for recurrent lesions, respectively. The overall survival (OS) rate, local control rate (LCR) and progression-free survival (PFS) were calculated by Kaplan-Meier analysis. Adverse reactions were also analyzed.Results:The most common sites of recurrence were 2R and 4 L, accounting for 35% and 25%, respectively. The median follow-up time was 32 months. For patients who received salvage chemoradiation after relapse, the 1-, 2- and 3-year OS rates were 100%, 88% and 78%, the 1-, 2- and 3-year PFS rates were 85%, 78% and 78%, respectively. The most common hematological toxicities were leukocytopenia and anemia. The most common nonhematological toxicity was esophagitis. However, no grade 3 or above esophagitis, pneumonia and cardiotoxicity were found. Three patients who received SIB-IMRT at 58.8 Gy/28 fractions died of distant metastases at 2 years after treatment, and 1 patient who received SIB-IMRT at 70.0 Gy/28 fractions died of distant metastases at 16 months after treatment.Conclusion:Salvage chemoradiotherapy using SIB-IMRT is efficacious and safe for mediastinal lymph node recurrence in ESCC patients after radical resection.