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Axillary lymph node dissection increases risk of arm swelling and lymphoedema in breast cancer patientsTrial Shows Axillary Surgery Predicts Long Term Arm Swelling
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and OncologyPublished July 24, 2026Study authors: Ravindra Saranya, Cafferty Fay H, Harris Emma, Gulliford Sarah, Miles Elizabeth, Patel Jaymini, Syde…PubMed ↗DOI ↗Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care
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Key Takeaway
Note that axillary lymph node dissection is a primary predictor of 5-year arm swelling and lymphoedema in breast cancer.
This randomized controlled trial enrolled 469 patients undergoing surgery and radiotherapy for node-positive breast cancer. The study compared different fractionation schedules, including 40 Gy/15Fr, 27 Gy/5Fr, or 26 Gy/5Fr to the breast, chest wall, and axilla. The primary outcome was non-inferiority for 5-year patient-reported arm/hand swelling.
At 5 years, 39/299 (13%) patients reported moderate or marked arm/hand swelling. Analysis showed an OR of 3.70 for ALND (95% CI [1.61-8.48], p = 0.002) and an OR of 3.31 for BMI $\geq$ 35 kg/m (95% CI [1.08-10.12], p = 0.036). Regarding clinician-reported arm lymphoedema, 45/346 (13%) patients were affected at 5 years. This was associated with an OR of 3.67 for ALND (95% CI [1.55-8.69], p = 0.003) and an OR of 1.08 for the number of positive lymph nodes (95% CI [1.00-1.18], p = 0.049).
Safety data were not reported, and no significant associations were found between individual dosimetric parameters and 5-year arm swelling in multivariable analysis. The findings suggest that axillary surgery is a primary predictor of long-term complications, supporting the de-escalation of ALND for patients with node-positive breast cancer.
How this fits prior evidence
How this fits prior evidence: This study addresses a gap in managing side effects and surgical impacts in breast cancer. While previous coverage noted that internal mammary and medial-supraclavicular irradiation reduces mortality without improving survival, this trial focuses on the local morbidity of axillary surgery. It identifies axillary lymph node dissection as a significant predictor for long-term arm swelling and lymphoedema, supporting de-escalation strategies to mitigate these specific complications.
Researchers conducted a trial involving 469 patients who underwent surgery and radiotherapy for node-positive breast cancer. The study focused on comparing different radiation schedules to see if they affected the risk of arm or hand swelling over a five-year period.
The results showed that 13% of patients reported moderate or marked arm swelling after five years, while another 13% were diagnosed with lymphedema by clinicians. The study found a significant link between axillary lymph node dissection and these conditions. Specifically, patients who had this surgery faced a higher risk of swelling compared to those who did not.
Other factors like high body mass index (BMI) also showed a link to increased swelling. While the study did not find specific radiation doses caused the issue, it highlights that surgical methods are a major factor in long-term outcomes. Patients should discuss these risks and potential de-escalation options with their doctors.
What this means for you:
Axillary lymph node dissection is linked to higher rates of arm swelling and lymphedema after breast cancer treatment.
Common questions
What are the risks of arm swelling after treatment?
In this study, about 13% of patients reported moderate or marked arm swelling at the five-year mark. Additionally, 13% were diagnosed with clinician-reported arm lymphedema. These conditions can occur following surgery and radiotherapy for breast cancer.
Does axillary lymph node dissection increase risk?
The study found a significant link between axillary lymph node dissection and long-term swelling. Patients who underwent this procedure had a higher reported risk of arm issues compared to those who did not, supporting the idea that surgery is a main predictor.
Do other factors like weight affect arm swelling?
The study found that a high body mass index (BMI) of 35 kg/m or more was linked to an increased risk of reported arm swelling. However, specific radiation doses were not found to have a significant link to the five-year outcomes.
PURPOSE/OBJECTIVE: The FAST-Forward randomised nodal sub-study primary analysis showed non-inferiority for 5-year patient-reported arm/hand swelling following adjuvant breast/chest wall and axillary radiotherapy given in 26 Gy in 5 fractions (Fr) over 1 week compared to 40 Gy in 15Fr over 3 weeks. This subsequent analysis investigates the association between patient, tumour and treatment factors and development of long-term arm/hand swelling.
MATERIAL/METHODS: Data from 469 patients randomised to adjuvant radiotherapy 40 Gy/15Fr, 27 Gy/5Fr or 26 Gy/5Fr to breast/chest wall and axilla (any or all levels 1-4) in the FAST-Forward nodal sub-study were included. DICOM-RT data were collected prospectively. ESTRO-defined axillary nodal levels 1-4, the axillary-lateral thoracic vessel juncture (ALTJ), and visible seroma were contoured retrospectively. Mean, maximum and minimum doses were extracted. Univariable and stepwise multivariable logistic regression were used to identify predictors of 5-year arm swelling.
RESULTS: At 5 years, moderate/marked arm/hand swelling was reported by 39/299 (13%) patients and clinician-reported arm lymphoedema by 45/346 (13%). Multivariable analysis identified axillary lymph node dissection (ALND) (OR 3.70, 95% CI [1.61-8.48], p = 0.002) and BMI ≥ 35 kg/m (OR 3.31 [1.08-10.12], p = 0.036) as significant predictors of 5-year patient-reported moderate/marked arm/hand swelling. For 5-year clinician-reported arm lymphoedema, multivariable analysis identified ALND (OR 3.67 [1.55-8.69], p = 0.003) and number of positive lymph nodes (OR 1.08 [1.00-1.18], p = 0.049) as significant predictors. No significant associations were found between individual dosimetric parameters and 5-year arm swelling on multivariable analysis.
CONCLUSION: Axillary surgery remains the main predictor of long-term arm lymphoedema following locoregional radiotherapy for node-positive breast cancer, supporting de-escalation of ALND to reduce this risk.
