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Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidance for the prevention of breast cancer-related arm lymphoedema (BCRAL): international Delphi consensus-based recommendations

2024; Elsevier BV; Volume: 68; Linguagem: Inglês

10.1016/j.eclinm.2024.102441

2589-5370

Henry C.Y. Wong, Matthew P. Wallen, Adrian Wai Chan, Narayanee Dick, Pierluigi Bonomo, Monique Bareham, Julie Ryan Wolf, Corina van den Hurk, Margaret I. Fitch, Edward Kai‐Hua Chow, Raymond J. Chan, Muna Alkhaifi, Belen Alonso Alvarez, Suvam Banerjee, Kira Bloomquist, Pierluigi Bonomo, Pınar Borman, Yolande Borthwick, Dominic C.W. Chan, Sze Man Chan, Yolanda Chan, Ngan Sum Jean Cheng, J. Isabelle Choi, Edward Kai‐Hua Chow, Yin Ping Choy, Kimberly S. Corbin, Elizabeth S. Dylke, Pamela V. Hammond, Satoshi Hirakawa, Kimiko Hirata, Shing Fung Lee, Marianne Ingerslev Holt, Peter A.S. Johnstone, Yuichiro Kikawa, Deborah Walker, Haruru Kotani, Carol Kwok, Jessica Lai, Mei Ying Lim, Michael Lock, Brittany Lorden, Page Mack, Stefano Magno, Icro Meattini, Gustavo Nader Marta, Margaret L. McNeely, Tammy E. Mondry, Luis López‐Montoya, Mami Ogita, Misato Osaka, Stephanie Phan, Philip Poortmans, Bolette Skjødt Rafn, Abram Recht, Agata Rembielak, Ángela Río-González, Jolien Robijns, Naoko Sanuki, Charles B. Simone, Mateusz Spałek, Kaori Tane, Luiz Felipe Nevola Teixeira, Mitsuo Terada, Mark Trombetta, Kam-Hung Wong, Katsuhide Yoshidome,

Breast Implant and Reconstruction

BackgroundDeveloping strategies to prevent breast cancer-related arm lymphoedema (BCRAL) is a critical unmet need because there are no effective interventions to eradicate it once it reaches a chronic state. Certain strategies such as prospective surveillance programs and prophylactic lymphatic reconstruction have been reported to be effective in clinical trials. However, a large variation exists in practice based on clinician preference, organizational standards, and local resources.MethodsA two-round international Delphi consensus process was performed from February 27, 2023 to May 25, 2023 to compile opinions of 55 experts involved in the care and research of breast cancer and lymphoedema on such interventions.FindingsAxillary lymph node dissection, use of post-operative radiotherapy, relative within-arm volume increase one month after surgery, greater number of lymph nodes dissected, and high body mass index were recommended as the most important risk factors to guide selection of patients for interventions to prevent BCRAL. The panel recommended that prospective surveillance programs should be implemented to screen for and reduce risks of BCRAL where feasible and resources allow. Prophylactic compression sleeves, axillary reverse mapping and prophylactic lymphatic reconstruction should be offered for patients who are at risk for developing BCRAL as options where expertise is available and resources allow. Recommendations on axillary management in clinical T1–2, node negative breast cancer patients with 1–2 positive sentinel lymph nodes were also provided by the expert panel. Routine axillary lymph node dissection should not be offered in these patients who receive breast conservation therapy. Axillary radiation instead of axillary lymph node dissection should be considered in the same group of patients undergoing mastectomy.InterpretationAn individualised approach based on patients' preferences, risk factors for BCRAL, availability of treatment options and expertise of the healthcare team is paramount to ensure patients at risk receive preventive interventions for BCRAL, regardless of where they are receiving care.FundingThis study was not supported by any funding. RJC received investigator grant support from the Australian National Health and Medical Research Council (APP1194051).