Reevaluating Intensive Treatment Strategies for Breast Cancer-Related Lymphedema Following Aggressive Therapy: A Retrospective Study

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Abstract
Purpose Aggressive breast cancer treatment increases the risk of breast cancer-related lymphedema(BCRL). However, whether all high-risk patients require equally intensive long-term management remains unclear. This study aimed to characterize the long-term manifestations of the BCRL pattern in patients who received aggressive cancer therapies yet showed favorable lymphoscintigraphy findings. Methods This retrospective study included 104 patients with BCRL with a history of mastectomy with axillary lymph node dissection and locoregional radiation therapy between 2008 and 2022, all of whom showed favorable lymphoscintigraphy findings. The patients were stratified into four groups based on their initial percentage of excessive volume(PEV). Volume changes and individualized lymphedema treatment during the first 12 months were analyzed. From months 12 to 24, the treatment intensity, including the frequency of medical compression therapy, was adjusted based on expert assessment. Results Despite similar treatment histories and lymphoscintigraphy findings, the patients showed different volume change patterns based on the initial PEV, although the overall outcomes were favorable over two years in all groups. Patients with BCRL and a low initial PEV maintained stable reduced volumes after 6 months of minimal or no compression therapy. However, the high-initial PEV group required active surveillance and long-term management despite favorable lymphoscintigraphy results. Conclusion Initial PEV effectively predicted long-term outcomes and treatment needs in patients with BCRL with an aggressive cancer treatment history and favorable lymphoscintigraphy findings. Personalized treatment planning using initial PEV and lymphoscintigraphy may provide the appropriate intensity of therapy to patients for an optimal duration to reduce time and financial burdens.

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