{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T15:03:45Z","timestamp":1793113425310,"version":"4.5.0"},"reference-count":27,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"29","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2020,10,10]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>To independently evaluate the impact of axillary surgery type and regional lymph node radiation (RLNR) on breast cancer\u2013related lymphedema (BCRL) rates in patients with breast cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PATIENTS AND METHODS<\/jats:title>\n                    <jats:p>From 2005 to 2018, 1,815 patients with invasive breast cancer were enrolled in a lymphedema screening trial. Patients were divided into the following 4 groups according to axillary surgery approach: sentinel lymph node biopsy (SLNB) alone, SLNB+RLNR, axillary lymph node dissection (ALND) alone, and ALND+RLNR. A perometer was used to objectively assess limb volume. All patients received baseline preoperative and follow-up measurements after treatment. Lymphedema was defined as a \u2265 10% relative increase in arm volume arising &gt; 3 months postoperatively. The primary end point was the BCRL rate across the groups. Secondary end points were 5-year locoregional control and disease-free-survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The cohort included 1,340 patients with SLNB alone, 121 with SLNB+RLNR, 91 with ALND alone, and 263 with ALND+RLNR. The overall median follow-up time after diagnosis was 52.7 months for the entire cohort. The 5-year cumulative incidence rates of BCRL were 30.1%, 24.9%, 10.7%, and 8.0% for ALND+RLNR, ALND alone, SLNB+RLNR, and SLNB alone, respectively. Multivariable Cox models adjusted for age, body mass index, surgery, and reconstruction type showed that the ALND-alone group had a significantly higher BCRL risk (hazard ratio [HR], 2.66; P = .02) compared with the SLNB+RLNR group. There was no significant difference in BCRL risk between the ALND+RLNR and ALND-alone groups (HR, 1.20; P = .49) and between the SLNB-alone and SLNB+RLNR groups (HR, 1.33; P = .44). The 5-year locoregional control rates were similar for the ALND+RLNR, ALND-alone, SLNB+RLNR, and SLNB-alone groups (2.8%, 3.8%, 0%, and 2.3%, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Although RLNR adds to the risk of lymphedema, the main risk factor is the type of axillary surgery used.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco.20.00459","type":"journal-article","created":{"date-parts":[[2020,7,30]],"date-time":"2020-07-30T16:02:31Z","timestamp":1596124951000},"page":"3430-3438","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":137,"title":["Quantifying the Impact of Axillary Surgery and Nodal Irradiation on Breast Cancer\u2013Related Lymphedema and Local Tumor Control: Long-Term Results From a Prospective Screening Trial"],"prefix":"10.1200","volume":"38","author":[{"given":"George E.","family":"Naoum","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA"},{"name":"Lymphedema Research Program, Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sacha","family":"Roberts","sequence":"additional","affiliation":[{"name":"Lymphedema Research Program, Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl L.","family":"Brunelle","sequence":"additional","affiliation":[{"name":"Lymphedema Research Program, Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy M.","family":"Shui","sequence":"additional","affiliation":[{"name":"Lymphedema Research Program, Massachusetts General Hospital, Boston, MA"},{"name":"Biostatistics Center, Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Salama","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA"},{"name":"Charles E. Schmidt College of Medicine, Boca Raton, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla","family":"Daniell","sequence":"additional","affiliation":[{"name":"Lymphedema Research Program, Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessa","family":"Gillespie","sequence":"additional","affiliation":[{"name":"Lymphedema Research Program, Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loryn","family":"Bucci","sequence":"additional","affiliation":[{"name":"Lymphedema Research Program, Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice Y.","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alphonse G.","family":"Taghian","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA"},{"name":"Lymphedema Research Program, Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(10)70207-2"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181c0e92a"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djj158"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70035-4"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.90"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2217\/bmt-2018-0018"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1415340"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31080"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2013.11.232"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s00066-017-1257-z"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.21037\/gs.2017.11.04"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(14)70460-7"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-018-6519-1"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s12609-017-0237-8"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2005.3.208"},{"key":"B17","author":"Naoum GE","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2010.01.001"},{"key":"B21","first-page":"64","volume":"46","author":"Miller CL","year":"2013","journal-title":"Lymphology"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-013-2715-7"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.11470"},{"key":"B25","first-page":"515","volume":"155","author":"Borup Christensen S","year":"1989","journal-title":"Acta Chir Scand"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2010.11.017"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsm1605385"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-016-3821-0"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-012-2111-8"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2018.03.046"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2019.06.2509"}],"container-title":["Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO.20.00459","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,29]],"date-time":"2022-05-29T06:23:08Z","timestamp":1653805388000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO.20.00459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,10]]},"references-count":27,"journal-issue":{"issue":"29","published-print":{"date-parts":[[2020,10,10]]}},"alternative-id":["10.1200\/JCO.20.00459"],"URL":"https:\/\/doi.org\/10.1200\/jco.20.00459","relation":{},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,10]]},"assertion":[{"value":"2020-06-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-07-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}