The Impact of External Beam Radiation Therapy on Shoulder Surgical Outcomes: A Case Series Study

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Journal of shoulder and elbow surgery


PURPOSE: External beam radiation therapy (XRT) is a commonly used treatment adjunct in patients with breast cancer, and is known to cause soft tissue dysfunction. However, data on XRT as a preoperative risk factor for shoulder surgery is limited. The purpose of this study is to assess whether prior history of breast cancer treated with XRT has an impact on surgical complications or outcomes.

METHODS: A 20-year, retrospective chart review across one large, academic health care system was performed. Inclusion criteria comprised any patient with history of breast cancer of the upper-outer or axillary region treated with XRT. Patients also must have undergone a surgical procedure to the ipsilateral shoulder with at least 1-year postoperative follow-up. Patients were stratified by demographics, hand-dominance, and surgery type. Postoperative outcomes including range of motion (ROM) and visual analogue scale (VAS) for pain were also collected.

RESULTS: Eighteen patients were identified (100% female) with an average age of 66.3 years (standard deviation 10.5 years). Ten shoulders underwent rotator cuff repair (RCR), four total shoulder arthroplasty (TSA), three Reverse Shoulder Arthroplasty (RSA) and one arthroscopic superior labrum anterior and posterior (SLAP) repair. Four patients treated with RCR (40%) experienced postoperative complications related to their procedure. These included scapular winging, adhesive capsulitis, stiffness, and one re-tear. Two patients treated with shoulder arthroplasty (28.6%) experienced postoperative complications which included lymphedema and peri-prosthetic fracture following a mechanical fall in one RSA patient and peri-prosthetic infection in one TSA patient. ROM across all groups improved, most significantly in forward flexion and internal rotation among RCR patients (p<0.001). Furthermore, a statistically significant improvement in VAS scores was achieved in each group (6.2 ± 2.14 preop, 1.06 ± 1.75 postop p<0.001).

CONCLUSION: When compared to national averages, complication rates in our cohort were higher (40% vs. 10-17% in RCR patients and 28.6% vs. 4-14% in arthroplasty patients). Upon further scrutiny, many of these complications were independent of a history of XRT and many resolved with appropriate therapy. Most importantly, functional outcomes as measured by ROM and pain scores showed appropriate improvement consistent with normal populations without history of XRT. Thus, our results suggest that performing shoulder surgery after ipsilateral XRT for breast cancer is likely safe, may offer improved pain and improved ROM compared to forgoing surgery without necessarily increasing the risk for postoperative complication.

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ePub ahead of print