Predictive Factors of Response to Decongestive Therapy in Patients with Breast-Cancer-Related Lymphedema
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- Forner-Cordero, I., Muñoz-Langa, J., Forner-Cordero, A. et al. Ann Surg Oncol (2010) 17: 744. doi:10.1245/s10434-009-0778-9
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Many studies have reported the benefits of Decongestive treatment in patients with breast-cancer-related lymphedema (BCRL) but few have study what are the predictive factors of response.
We performed a prospective, multicenter controlled cohort study of 171 patients with BCRL to identify independent predictive factors of response to decongestive treatment (CDT). Demographic data and clinical and lymphedema characteristics were collected prospectively. The end point was the “percentage reduction in excess volume (PREV).” Volumes were measured prior and at the end of CDT. Factors associated with response (PREV) were tested in univariate and multivariate analyses using linear regression techniques.
Median age was 60.4 years (range 32–84); mean lymphedema chronicity 4 years [95% confidence interval (95% CI): 3.1–5.0]; mean baseline excess volume (EV) was 936 mL (95% CI: 846–1026), and mean percentage EV was 35.3% (95% CI: 32.0–38.7); compliance to bandages was good in 81.3% of patients. PREV was 71.7% (95% CI: 65.2–78.2). After univariate screening, 11 variables were found to be associated with PREV but only 4 variables were independent predictive factors of response to CDT in the multivariate analysis: Venous insufficiency, percentage of EV (the higher the EV, the lower the reduction with CDT); compliance to bandages (a good compliance improved PREV in 25%), and treatment in autumn (better results than during the rest of the year).
This study shows that compliance to bandages during CDT is one of the most important predictors of response. Moreover, data support the idea that more severe lymphedemas have a worse response to treatment, and it should be recommended in early stages. The association between the season of treatment and response was also very strong, so weather conditions are an additional factor that must be taken into account in further studies.