Chirag Shah, MD, Director of Breast Radiation Oncology and Director of Clinical Research in the Department of Radiation Oncology at Cleveland Clinic. In this video, he speaks about the abstract – A Comparison of Bioimpedance Spectroscopy or Tape Measure Triggered Compression Intervention in Chronic Breast Cancer Lymphedema Prevention.
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Overview –
Origins:
Following a subclinical lymphedema (S-BCRL) intervention triggered by bioimpedance spectroscopy (BIS) or tape measurement, rates of progression to chronic breast cancer-related lymphedema (defined as a 10% arm volume change from baseline requiring complex decongestive physiotherapy [CDP]) were compared (TM).
Findings and Methodologies:
New breast cancer patients undergoing mastectomy/partial mastectomy, axillary treatment (dissection, sentinel lymph node biopsy [SLNB] >6 nodes or radiation), radiation therapy (chest wall/breast, supraclavicular fossa), or taxane-based chemotherapy were enrolled in this stratified, randomized, international trial. Following a centralized, 1:1 randomization to prospective surveillance by BIS or TM, patients were randomized to prospective surveillance by BIS or TM. When S-BCRL was detected, a 4-week, 12-hour-per-day compression sleeve and gauntlet intervention was initiated. Over a three-year period, the primary outcome (n = 209) was assessed: rates of postintervention progression to CDP. 1200 individuals were enrolled between June 24, 2014 and September 11, 2018, with 963 being randomized (BIS n = 482; TM n = 481) and 879 being analyzed (BIS n = 442; TM n = 437). The median time between visits was 32.9 months (interquartile range = 22, 35). BIS patients were less likely than TM patients to require intervention (20.1 percent, n = 89 vs. 27.5 percent, n = 120, p = 0.011). BIS took longer to trigger than TM (9.7; 95 percent confidence interval [CI], 8.2–12.6 vs. 3.9; 95 percent confidence interval [CI], 2.8–4.5, p = 0.001). Overall, 14.4% (n = 30) of BIS patients advanced after treatment, with a lower chance for TM patients (7.9%, n = 7 vs. 19.2%, n = 23; relative risk = 0.41; 95 percent CI, 0.13–0.81; absolute reduction 11.3 percent; 95 percent CI, 2.3–20.3; p = 0.016).
Observations:
In comparison to TM, BIS allows for a more exact diagnosis of patients who would benefit from early compression therapy.
NCT02167659 is the number assigned to a clinical trial.