Lymphedema Secondary to Postmastectomy Radiation: Incidence and Risk Factors Christian S. Hinrichs, MD, Nancy L. Watroba, MPA, Hamed Rezaishiraz, MD, William Giese, MD, JD, Thelma Hurd, MD, Kathleen A. Fassl, PT, BS, and Stephen B. Edge, MD Background: Postmastectomy radiotherapy (PMRT) has proven benefits for certain patients with breast cancer; however, one of its complications is lymphedema. This study examines the incidence of and risk factors associated with lymphedema secondary to PMRT. Methods: The charts of patients treated with mastectomy at Roswell Park Cancer Institute between January 1, 1995, and April 20, 2001, who received PMRT were reviewed. Univariate analysis of patient, disease, and treatment variables was conducted. Multivariate analysis was performed on variables found to be significant in univariate analysis. Results: One hundred five patients received PMRT. The incidence of lymphedema was 27%. Patient age, body mass index, disease stage, positive lymph nodes, nodes resected, postoperative infection, duration of drainage, chemotherapy, and hormonal therapy were not associated with lymphedema. Total dose (P = .032), posterior axillary boost (P = .047), overlap technique (P = .037), radiotherapy before 1999 (P = .028), and radiotherapy at Roswell Park Cancer Institute (P = .028) were significantly associated with lymphedema. Increased lymphedema was noted with supraclavicular, internal mammary, mastectomy scar boost, and chest wall tangential photon beam radiation, but the associations were not statistically significant. Conclusions: The high incidence and debilitating effects of lymphedema must be weighed against the benefits of PMRT. Efforts to prevent lymphedema should be emphasized. Key Words: Lymphedema—Postmastectomy radiation—Risk factors—Complications—Breast neoplasms. Postmastectomy radiotherapy (PMRT) reduces locore- gional failure and prolongs disease-free survival and overall survival for certain patients with breast cancer. 1–5 However, PMRT carries a risk of lymphedema, brachial plexopathy, impaired shoulder mobility, chronic pain, skin fibrosis and telangiectasia, rib fractures, pulmonary fibrosis, and ischemic heart disease. 6 –18 Lymphedema is a chronic, incurable condition, the effects of which include limb swelling, heaviness, tight- ness, and pain. 19,20 In addition, it takes a psychological toll, causing anxiety, depression, and adjustment prob- lems. Lymphedema affects the vocational, domestic, so- cial, and sexual lives of those it afflicts, and it negatively affects quality of life. 21–27 It also places patients at in- creased risk for life-threatening soft tissue infections and malignancies. 28 –32 Despite its debilitating effects, the incidence of lymphedema secondary to PMRT, delivered with mod- ern radiotherapy techniques, has not been widely re- ported. Furthermore, controversy exists as to which pa- tient, disease, and treatment factors place individuals at higher risk for developing lymphedema. The intent of this study was to determine the incidence of lymphedema secondary to PMRT and to identify the risk factors associated with its occurrence. Received April 11, 2003; accepted March 3, 2004. From the Departments of Surgical Oncology (CSH, NLW, TH, SBE), Cancer Prevention (HR), Radiation Medicine (WG), and Phys- ical Therapy (KAF), Roswell Park Cancer Institute, Buffalo, New York. Address correspondence and reprint requests to: Stephen B. Edge, MD, Roswell Park Cancer Institute, Department of Surgical Oncology, Elm and Carlton Streets, Buffalo, NY 14263; Fax: 716-845-1668; E-mail: stephen.edge@roswellpark.org. Published by Lippincott Williams & Wilkins © 2004 The Society of Surgical Oncology, Inc. Annals of Surgical Oncology, 11(6):573–580 DOI: 10.1245/ASO.2004.04.017 573