02078nas a2200193   4500000000100000008004100001653002400042653001200066100001700078700001600095700001100111700001700122700001300139245008200152300001200234490000800246050000600254520162400260       2008                            d10aPeer Reviewed Paper10aChecked1 aRefshauge K.1 aHerbert Rob1 aLee T.1 aKilbreath S.1 aBeith J.00aPrognosis of the upper limb following surgery and radiation for breast cancer  a19-37. 0 v110  aY3 a<p>
The aim of this systematic review was to identify the prevalence and severity of upper limb problems following surgery and radiation for early breast cancer. Additionally, the independent prognostic contribution of radiation, type of breast surgery, type of axillary surgery, age and body mass index (BMI) was evaluated. Searches of electronic databases were conducted to identify articles that reported upper limb and quality of life outcomes after breast cancer surgery and external radiation. Eligible studies for prognosis were longitudinal in design, with &gt;/=95% of patients treated by surgery and radiation that excluded the axilla. Cross-sectional studies were also included for identification of prognostic factors. Where possible, the contribution of independent prognostic factors was analyzed. The review identified 32 relevant studies. Shoulder restriction was reported in between &lt;1% and 67% of participants, lymphedema was reported in between 0 and 34% of participants, shoulder/arm pain was reported in between 9 and 68% of participants and arm weakness was reported in between 9 and 28% of participants. Quality of life was high across studies. Irradiated patients had slightly increased odds of lymphedema (OR = 1.46, 95% CI 1.16-1.84) and shoulder restriction (OR = 1.67, 95% CI 0.98-2.86) compared with non-irradiated patients. For patients undergoing surgery and radiation for breast cancer, the prognosis is good in terms of the upper limb and quality of life. Radiation that excludes the axilla does not appear to be a strong prognostic indicator of adverse upper limb outcomes.
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