The online version of this article (doi:10.1186/1477-7819-10-86) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests. The first author (NA) is a bursary of the IWT, Belgian Agency for Innovation by Science and Technology, http://www.iwt.be/. The trial was funded by grant SCIE2006-30 from the Stichting tegen Kanker, Belgian Foundation against Cancer, http://www.kanker.be/. The Radiotherapy Department of the University Hospital, Brussels had a research agreement with TomoTherapy Inc. (Madison, WI, USA) and Orfit Industries (Wijnegem, Belgium). None of the funding agencies were involved in the study design; in the collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.
NA was the trial's co-investigator, designed the study, collected and analysed the data, and drafted the manuscript. MDR was the trial's director, edited and critically reviewed the manuscript. PL, MVo, and GS edited and critically reviewed the manuscript. HVP was the trial's co-investigator, collected the data, and drafted the manuscript. MVa collected the data, ensured patients’ follow-up, and edited the manuscript. GM collected data, evaluated patients, edited and critically reviewed the manuscript. HV did the data management, and drafted the manuscript. JL contributed to patients’ follow-up, edited and reviewed the manuscript. SP contributed to data collection and to manuscript writing. VVH was the trial's principal investigator, provided the study concept, analysed the data analysis, and wrote the manuscript. All authors read and approved the final manuscript.
Scapula alata (SA) is a known complication of breast surgery associated with palsy of the serratus anterior, but it is seldom mentioned. We evaluated the risk factors associated with SA and the relationship of SA with ipsilateral shoulder/arm morbidity in a series of patients enrolled in a trial of post-surgery radiotherapy (RT).
The trial randomized women with completely resected stage I-II breast cancer to short-course image-guided RT, versus conventional RT. SA, arm volume and shoulder-arm mobility were measured prior to RT and at one to three months post-RT. Shoulder/arm morbidities were computed as a post-RT percentage change relative to pre-RT measurements.
Of 119 evaluable patients, 13 (= 10.9%) had pre-RT SA. Age younger than 50 years old, a body mass index less than 25 kg/m2, and axillary lymph node dissection were significant risk factors, with odds ratios of 4.8 (P = 0.009), 6.1 (P = 0.016), and 6.1 (P = 0.005), respectively. Randomization group was not significant. At one to three months’ post-RT, mean arm volume increased by 4.1% (P = 0.036) and abduction decreased by 8.6% (P = 0.046) among SA patients, but not among non-SA patients. SA resolved in eight, persisted in five, and appeared in one patient.
The relationship of SA with lower body mass index suggests that SA might have been underestimated in overweight patients. Despite apparent resolution of SA in most patients, pre-RT SA portended an increased risk of shoulder/arm morbidity. We argue that SA warrants further investigation. Incidentally, the observation of SA occurring after RT in one patient represents the second case of post-RT SA reported in the literature.
Additional file 1: Appendix 1. Computing volume from circumference measurements for TomoBreast patients: Appendix 2. A list of variables used for imputation of missing data; Appendix 3. The relationships between scapula alata and characteristics; Appendix 4. Logistic regression, all variables without selection; Appendix 5. Figure of shoulder/arm percentage changes from pre- to post-radiotherapy, according to scapula alata status; Appendix 6: Post-radiotherapy outcomes (percentage change of shoulder/arm measurement between pre- and post-RT) and linear predictors. (DOC 169 KB)12957_2011_1072_MOESM1_ESM.doc
Additional file 2: File format PDF. Brown.combined.Pvalues. (PDF 7 KB)12957_2011_1072_MOESM2_ESM.pdf
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- Scapula alata in early breast cancer patients enrolled in a randomized clinical trial of post-surgery short-course image-guided radiotherapy
Mark De Ridder
Hilde Van Parijs
- BioMed Central
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