LYMPH CIRCULATION IN THE BREAST AFTER RADIOTHERAPY AND BREAST CONSERVATION

Abstract

The aim of this study was to investigatethe breast lymph circulation and skin bloodcirculation after radiotherapy and breastconservation. In 23 patients who hadundergone lumpectomy for breast cancer(mean age 58 years, range 44-75) and 12patients with lumpectomy for benign lesions(mean age 51 years, range 33-72), lymphcirculation in the breast was measured by99mTc-nanocolloid clearance and skincirculation by Laser Doppler Fluxmetry(LDF). Measurements were made 2-5 yearsafter radiotherapy (50 Gy) in the formergroup and at a corresponding time in thelatter. The lymph circulation was measured2 cm above and medial or lateral to theareolar border in the quadrant not operatedon for carcinoma. Skin circulation wasmeasured at corresponding sites. The lymphcirculation expressed as the ratio of99mTc-nanocolloid clearance in the operatedirradiated to that in the non-operated(radiation 2-4 Gy) breast was 2.33 (2.66)(median, interquartile range) (p value 0.01)and the skin circulation ratio over thecorresponding area was 0.92 (0.21).Corresponding ratios in the non-radiotherapygroup were 2.07 (1.96) (p value 0.03) and 1.04(0.18) respectively. Compared with the controlbreast (i.e., the non-operated non-irradiatedbreast), there was a 4-fold increase in lymphflow in the operated, irradiated breast, a2.5-fold increase in the contralateral nonoperated(2-4 Gy) breast and a 1.5-fold increasein the operated non-irradiated breast. Radiotherapyafter breast conservation surgery leadsto increased long-term changes in basal lymphcirculation and smaller increases in lymphflow in the contralateral breast receiving 2-4Gy and after surgery. If maximal lymphtransport capacity is unchanged, edema maybe more likely in this circumstance of reducedlymphatic transport reserve.