A case-control study of pectoralis major muscle quality in breast cancer survivors after radiation therapy without prior axillary lymph node dissection

Radiation therapy for breast cancer is associated with considerable radiation to the pectoralis major, which causes muscle fibrosis and reduces muscle quality. The present study examined pectoralis major muscle quality after radiation therapy in breast cancer survivors using ultrasound echo intensity (EI). Twelve breast cancer survivors treated with radiation therapy to breast and axilla (breast + axilla group) and twelve survivors treated with radiation therapy to the breast only (breast only group) were compared to twelve cancer-free control women. All breast cancer survivors underwent breast-conserving surgery and sentinel node biopsy before radiation therapy. The pectoralis major was imaged with ultrasound on the treated side in breast cancer survivors and a randomly chosen side in controls. EI values were acquired from these images as a measure of muscle quality. Total body fat percentage was obtained from DXA scans. EI of the pectoralis major differed between the groups (p = 0.013), where EI values were higher in the breast + axilla group (p = 0.049) and breast only group (p = 0.013) compared to controls. Mediation-based regression analysis showed that the effect of radiation on EI is significantly mediated by body fat percentage. Higher pectoralis major EI in the breast cancer groups suggests lower muscle quality after radiation therapy, which may contribute to the shoulder functional deficits experienced by many breast cancer survivors. The findings suggest that this poorer muscle quality may result from higher body fat percentage and is exacerbated by radiation exposure.