Radiation dose to shoulder joint linked to arm problems in breast cancer patients
A major Swedish trial found that higher radiation doses to the shoulder joint significantly worsen arm function and mobility in breast cancer survivors three years after treatment—but only in patients who undergo breast-conserving surgery. The finding could reshape treatment planning and improve quality of life for thousands of patients, yet researchers still lack clear dose guidelines for clinical practice.
Originaltitel: Association between shoulder joint radiation dose and arm morbidity in the randomized breast cancer trial SENOMAC
BACKGROUND: Postoperative lymph node irradiation can affect shoulder morbidity in breast cancer patients, yet widely accepted dose-volume constraints for the shoulder joint are lacking. The SENOMAC trial randomized patients with breast cancer and 1-2 sentinel lymph node (SLN) macrometastases to axillary lymph node dissection (ALND) or SLN biopsy only. We aimed to analyze the association between the radiation dose to the shoulder joint and patient-reported arm morbidity one and three years after surgery using SENOMAC data. METHODS: Radiotherapy plans from 868 Swedish SENOMAC patients randomized 2015-2019 were collected. The humeral head was auto-segmented, and a 1 cm margin added to represent the shoulder joint. Arm morbidity was assessed using the Lymph-ICF questionnaire, focusing on questions regarding physical arm function and shoulder-related mobility tasks. RESULTS: ) was associated with significantly worse arm morbidity scores three years after surgery, particularly among patients treated with breast-conserving surgery. No association was found in the ALND group. No dose thresholds for development of arm/shoulder related side effects could be identified. CONCLUSION: Our results indicate a possible association between maximum radiation dose to the shoulder joint and subsequent side effects. Extended follow-up within SENOMAC will provide further insights into the incidence of arm morbidity in relation to radiotherapy dose over time.