Scapula alata in early breast cancer patients enrolled in a randomized clinical trial of post-surgery short-course image-guided radiotherapy

World Journal of Surgical Oncology

Research

Jan Lamote¹  Marian Vanhoeij¹  Nele Adriaenssens²  Mark De Ridder³  Mia Voordeckers³  Geertje Miedema³  Harijati Versmessen³  Hilde Van Parijs³  Guy Storme³  Vincent Vinh-Hung⁴  Stephanie Pauwels⁵  Pierre Lievens⁵ 

[1] Breast Clinic, Oncologic Surgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium;Breast Clinic, Oncologic Surgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium;Physical Therapy Department, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium;Department of Radiotherapy, Oncology Centre, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium;Department of Radiotherapy, Oncology Centre, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium;Radiation Oncology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland;Physical Therapy Department, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium;

关键词: Breast cancer;    Surgery;    Radiation treatment;    Complications;    Winged scapula;    Scapular winging;    Long thoracic nerve;    Multiple outcomes;    Shoulder/arm morbidity;    Lymphedema;   

DOI  :  10.1186/1477-7819-10-86

 received in 2011-12-15, accepted in 2012-05-16,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundScapula alata (SA) is a known complication of breast surgery associated with palsy of the serratus anterior, but it is seldom mentioned. We evaluated the risk factors associated with SA and the relationship of SA with ipsilateral shoulder/arm morbidity in a series of patients enrolled in a trial of post-surgery radiotherapy (RT).MethodsThe trial randomized women with completely resected stage I-II breast cancer to short-course image-guided RT, versus conventional RT. SA, arm volume and shoulder-arm mobility were measured prior to RT and at one to three months post-RT. Shoulder/arm morbidities were computed as a post-RT percentage change relative to pre-RT measurements.ResultsOf 119 evaluable patients, 13 (= 10.9%) had pre-RT SA. Age younger than 50 years old, a body mass index less than 25 kg/m2, and axillary lymph node dissection were significant risk factors, with odds ratios of 4.8 (P = 0.009), 6.1 (P = 0.016), and 6.1 (P = 0.005), respectively. Randomization group was not significant. At one to three months’ post-RT, mean arm volume increased by 4.1% (P = 0.036) and abduction decreased by 8.6% (P = 0.046) among SA patients, but not among non-SA patients. SA resolved in eight, persisted in five, and appeared in one patient.ConclusionThe relationship of SA with lower body mass index suggests that SA might have been underestimated in overweight patients. Despite apparent resolution of SA in most patients, pre-RT SA portended an increased risk of shoulder/arm morbidity. We argue that SA warrants further investigation. Incidentally, the observation of SA occurring after RT in one patient represents the second case of post-RT SA reported in the literature.

【 授权许可】

Unknown   
© Adriaenssens et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.