Association between shoulder joint radiation dose and arm morbidity in the randomized breast cancer trial SENOMAC
Year: 2026
Type: article
Abstract: BACKGROUND: Postoperative lymph node irradiation can affect shoulder morbidity in breast cancer patients, yet widely accepted dose-volume constraints for the shoulder joint are lacking. The SENOMAC trial randomized patients with breast cancer and 1-2 sentinel lymph node (SLN) macrometastases to axillary lymph node dissection (ALND) or SLN biopsy only. We aimed to analyze the association between the radiation dose to the shoulder joint and patient-reported arm morbidity one and three years after surgery using SENOMAC data. METHODS: Radiotherapy plans from 868 Swedish SENOMAC patients randomized 2015-2019 were collected. The humeral head was auto-segmented, and a 1 cm margin added to represent the shoulder joint. Arm morbidity was assessed using the Lymph-ICF questionnaire, focusing on questions regarding physical arm function and shoulder-related mobility tasks. RESULTS: ) was associated with significantly worse arm morbidity scores three years after surgery, particularly among patients treated with breast-conserving surgery. No association was found in the ALND group. No dose thresholds for development of arm/shoulder related side effects could be identified. CONCLUSION: Our results indicate a possible association between maximum radiation dose to the shoulder joint and subsequent side effects. Extended follow-up within SENOMAC will provide further insights into the incidence of arm morbidity in relation to radiotherapy dose over time.
Source: Radiotherapy and Oncology
Authors: Sara Alkner, Matilda Appelgren, Robert Szulkin, Elinore Wieslander, Viktor Rogowski, Christian Jamtheim Gustafsson, Henrik Dahl Nissen, Helena Sackey, Dan Lundstedt, Yvette Andersson, Leif Bergkvist, Jan Frisell, Roger Olofsson Bagge, Malin Sund, Lisa Rydén, Birgitte Vrou Offersen, Jana de Boniface
Institutions: Lund University, Skåne University Hospital, Karolinska Institutet, Vejle Sygehus, Karolinska University Hospital, Sahlgrenska University Hospital, University of Gothenburg, Uppsala University, Västmanlands sjukhus Västerås, Region Västmanland, Wallenberg Centre for Molecular and Translational Medicine, University of Helsinki, Helsinki University Hospital, Umeå University, Aarhus University, Aarhus University Hospital, Saint Göran Hospital
Language: English
Subfield: Cancer Research
Domain: Life Sciences
Open Access status: hybrid
Estimated APC paid: $3,770
Awards: G1468905745, G187211583, G1937510724, G3428106879, G5530896106, G5673920549, Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection – the randomized SENOMAC trial, Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection – the randomized SENOMAC trial., G7248966288, G7771654580, G8869434652
OpenAlex ID: W7130822397