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Supraclavicular radiotherapy must be limited laterally by the coracoid to avoid significant adjuvant breast nodal radiotherapy lymphoedema risk


  • P Graham MB BS, FRANZCR, Cert Biothics, Grad Dip Med Stat; R Jagavkar MB BS, FRANZCR; L Browne BSc, PhD, Grad Dip Med Stat, AStat; E Millar FRCPath, FRCPA.

    Present address: R Jagavkar, Department of Radiotherapy, St Vincents Hospital, Sydney, New South Wales, Australia.‡E Millar, Department of Anatomical Pathology, South Eastern Laboratory Service, St George Hospital, Sydney, New South Wales, Australia.

Associate Professor P Graham, Cancer Care Centre, Short Street, St George Hospital, Kogarah, NSW 2217, Australia. Email:


This cross-sectional study aimed to investigate the effect of supraclavicular fossa (SCF) radiotherapy volumes as well as patient characteristics and nodal pathology on the development of lymphoedema. Ninety-one women who had received SCF nodal radiotherapy after axillary dissection were evaluated. Lymphoedema was defined by two measurements: limb volume difference 200 mL, or circumference difference 10 cm proximal or distal to the olecranon >2 cm. On univariate analysis, the addition of axillary to SCF radiotherapy, increasing width of the SCF field, increasing age, presence of extracapsular extension of nodal involvement and use of hormone treatment was associated with lymphoedema by either one or both definitions. For both definitions of lymphoedema, on multivariate analysis, increasing nodal radiotherapy volume remained significant (P = 0.02 to 0.007), as did increased age (P = 0.05 to 0.001). We conclude that conventionally fractionated SCF radiotherapy limited laterally by the coracoid process has a lymphoedema risk similar to that expected from axillary dissection alone and a lower risk than wider SCF fields with or without an axillary boost.