Response to letter to the editor

Excerpt

We thank Dr. Altundag for the thoughtful remarks on our recently published article “Changes in volume and incidence of lymphedema during and after treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC) in patients with breast cancer” [1]. Nowadays, in a large proportion of institutions, cytotoxic treatment is administered in the neoadjuvant setting. Indeed, taxanes in a neoadjuvant setting are less likely to induce development of lymphedema, although evidence is scarce. In a sub-analysis of patients treated with taxanes, Cariati et al. compared neoadjuvant treatment with adjuvant treatment [2]. In both settings, patients developed lymphedema. However, in the neoadjuvant setting, 20% of the patients developed lymphedema, compared to 43% in the adjuvant setting [2]. This implies that although the risk of development of lymphedema is decreased in the neoadjuvant setting, still a substantial proportion of patients suffer from lymphedema. Also, a decrease in muscle strength has been described [3]. Importantly, the effects of neoadjuvant breast cancer treatment on other arm and shoulder problems are still largely unknown. Further research in this area, both with respect to short-term and long-term results, is urgently needed. …