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The Effects of Radiation on the Lymphatic Anatomy of the Chest
Shayan M. Sarami, MD
Casey Zhang, BS
Meeti Mehta, BS
Carolyn De La Cruz, MD
University of Pittsburgh
2024-01-14
Presenter: Shayan M. Sarrami
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. 100% of the work on this project is original work by the authors.
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
Breast cancer related truncal lymphedema is a difficult post-surgical complication that is not well understood. Radiation is a known risk factor of lymphedema development, but the extent of its damage to truncal lymphatics has never been assessed. We aim to analyze the effects of radiation on lymphatic structures of the trunk using ICG lymphography.
Methods
Patients included in this study underwent truncal ICG lymphography between June – November 2023. Patients were separated into the prior radiation group or control group. Different lymphatic flow patterns were assessed including no flow, representing diffuse lymphatic damage. Univariate analysis and multivariable logistic regressions were performed using SPSSv24.0 with p≤0.05 considered statistically significant.
Results
Our cohort included 26 unique sides (15 patients). Seventeen sides (63%) had undergone prior radiation and 9 had not. 70% of patients underwent mastectomy, 52% had chemotherapy, and 26% had axillary dissection. Lymphatic drainage to the ipsilateral groin was seen in 70% of chest lymphographies, cross-body drainage was seen in 19%, and no flow was seen in 44%. Prior radiation was significantly associated with the absences of lymphatic flow (p=0.014). On multivariate analysis, controlling for confounding chemotherapy and axillary dissection, radiation was associated with 14.05 times increase in odds of absent lymphatic flow.
Conclusion
We show that prior radiation is significantly associated with no flow on ICG lymphography. This represents severe damage to lymphatic vessels and an absence of drainage from the chest. Our results suggest that vessel fibrosis following radiation results in far more lymphatic damage than previously thought.
