This study aims to examine literature on effectiveness of low-level laser therapy (LLLT) in reducing limb volume and pain in adults with breast cancer-related lymphedema (BCRL).
PubMed, PEDro, CINAHL, and Cochrane databases were searched using (lymphedema OR edema OR swelling) AND (breast cancer OR mastectomy) AND (laser OR low-level laser therapy OR LLLT OR cold laser). Intervention studies or meta-analyses reporting LLLT for BCRL were included in the search. Pooled effect sizes (ES) and 95 % confidence intervals (CI) were calculated for volume and pain. No limitations were placed on length of follow-up, publication year, or language. Final search was conducted on October 16, 2014.
Nine studies met criteria for inclusion. Within-group pooled ES for volume (six studies) was −0.52 (−0.78, −0.25), representing a 75.7-ml reduction in limb volume after LLLT. Between-group pooled ES for volume (four studies) was −0.62 (−0.97, −0.28), representing a 90.9-ml greater reduction in volume with treatment including LLLT versus not including LLLT. Within-group pooled ES for pain reduction (three studies) was −0.62 (−1.06, −0.19), pain reduction of 13.5 mm (0–100 mm VAS). Between-group pooled ES for pain reduction (two studies) was non-significant at −1.21 (−4.51, 2.10).
Moderate-strength evidence supports LLLT in the management of BCRL, with clinically relevant within-group reductions in volume and pain immediately after conclusion of LLLT treatments. Greater reductions in volume were found with the use of LLLT than in treatments without it.
Implications for Cancer Survivors
LLLT confers clinically meaningful reductions in arm volume and pain in women with BCRL.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500–15.
Smoot B, Wong J, Cooper B, Wanek L, Topp K, Byl N, et al. Upper extremity impairments in women with or without lymphedema following breast cancer treatment. J Cancer Surviv. 2010;4(2):167–78.
Dawes DJ, Meterissian S, Goldberg M, Mayo NE. Impact of lymphoedema on arm function and health-related quality of life in women following breast cancer surgery. J Rehabil Med. 2008;40(8):651–8.
Hayes SC, Johansson K, Stout NL, Prosnitz R, Armer JM, Gabram S, et al. Upper-body morbidity after breast cancer: incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care. Cancer. 2012;118(8 Suppl):2237–49.
Ridner SH. Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema. Support Care Cancer. 2005;13(11):904–11.
Maiya A, Olivia E, Dibya A. Effect of low energy laser therapy in the management of post-mastectomy lymphoedema. Physiother Sing. 2008;11:2–5.
Hwang JM, Hwang JH, Kim TW, Lee SY, Chang HJ, Chu IH. Long-term effects of complex decongestive therapy in breast cancer patients with arm lymphedema after axillary dissection. Ann Rehabil Med. 2013;37:690–7.
Huang TW, Tseng SH, Lin CC, Bai CH, Chen CS, Hung CS, et al. Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials. World J Surg Oncol. 2013;11:15.
Stout NL, Pfalzer LA, Springer B, Levy E, McGarvey CL, Danoff JV, et al. Breast cancer-related lymphedema: comparing direct costs of a prospective surveillance model and a traditional model of care. Phys Ther. 2012;92(1):152–63.
Thiel H. Low power laser therapy—an introduction and a review of some biological effects. J Can Chiropr Assoc. 1986;30(3):133–8.
Cameron M. Electromagnetic radiation: lasers and light. In: Cameron MH, editor. Physical agents in rehabilitation: from research to practice. 3rd ed. St. Louis: Saunders; 2009.
Lievens P. The influence of laser-irradiation on the motricity of the lymphatical system and on the wound healing process. In: Proceedings International Congress on Laser in Medicine and Surgery, Bologna, June 26–28, 1985. Monduzzi. 1985:171–4.
Lievens P. The effect of a combined HeNe and IR laser treatment on the regeneration of the lymphatic system during the process of wound healing. Lasers Med Sci. 1991;6(2):193–9.
Assis L, Moretti AI, Abrahao TB, de Souza HP, Hamblin MR, Parizotto NA. Low-level laser therapy (808nm) contributes to muscle regeneration and prevents fibrosis in rat tibialis anterior muscle after cryolesion. Lasers Med Sci. 2013;28(3):947–55.
Omar MT, Shaheen AA, Zafar H. A systematic review of the effect of low-level laser therapy in the management of breast cancer-related lymphedema. Support Care Cancer. 2012;20(11):2977–84.
Lima ME, Lima J, de Andrade M, Bergmann A. Low-level laser therapy in secondary lymphedema after breast cancer: systematic review. Lasers Med Sci. 2014;29:1289–95.
Moseley AL, Carati CJ, Piller NB. A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. Ann Oncol. 2007;18(4):639–46.
Flórez-García MT, Valverde-Carrillo MD. Effectiveness of nonpharmacological interventions in the management of lymphedema postmastectomy. Rehabilitacion. 2007;41(3):126–34.
Ridner SH, Poage-Hooper E, Kanar C, Doesram JK, Bond SM, Dietrich MS. A pilot randomized trial evaluating low-level laser therapy as an alternative treatment to manual lymphatic drainage for breast cancer-related lymphedema. Oncol Nurs Forum. 2013;40:383–93.
Piller N, Thelander A. Treating chronic postmastectomy lymphedema with low level laser therapy: a cost effective strategy to reduce severity and improve quality of survival. Laser Ther. 1995;7(23):163–8.
Piller NB, Thelander A. Treatment of chronic postmastectomy lymphedema with low level laser therapy: a 2.5 year follow-up. Lymphology. 1998;31(2):74–86.
Carati CJ, Anderson SN, Gannon BJ, Piller NB. Treatment of postmastectomy lymphedema with low-level laser therapy: a double blind, placebo-controlled trial. Cancer. 2003;98(6):1114–22.
Dirican A, Andacoglu O, Johnson R, McGuire K, Mager L, Soran A. The short-term effects of low-level laser therapy in the management of breast-cancer-related lymphedema. Support Care Cancer. 2011;19(5):685–90.
Kaviani A, Fateh M, Yousefi Nooraie R, Alinagi-zadeh MR, Ataie-Fashtami L. Low-level laser therapy in management of postmastectomy lymphedema. Lasers Med Sci. 2006;21(2):90–4.
Kozanoglu E, Basaran S, Paydas S, Sarpel T. Efficacy of pneumatic compression and low-level laser therapy in the treatment of postmastectomy lymphoedema: a randomized controlled trial. Clin Rehabil. 2009;23(2):117–24.
Lau RW, Cheing GL. Managing postmastectomy lymphedema with low-level laser therapy. Photomed Laser Surg. 2009;27(5):763–9.
Omar M, Abd-El-Gayed Ebid A, El Morsy A. Treatment of post-mastectomy lymphedema with laser therapy: double blind placebo control randomized study. J Surg Res. 2011;165(1):82–90.
Bird SB, Dickson EW. Clinically significant changes in pain along the visual analog scale. Ann Emerg Med. 2001;38(6):639–43.
Stubblefield MD, Keole N. Upper body pain and functional disorders in patients with breast cancer. PM R. 2014;6(2):170–83.
Teerachaisakul M, Ekataksin W, Durongwatana S, Taneepanichskul S. Risk factors for cellulitis in patients with lymphedema: a case-controlled study. Lymphology. 2013;46(3):150–6.
de Godoy JMP, da Silva SH. Prevalence of cellulitis and erysipelas in post-mastectomy patients after breast cancer. Arch Med Sci. 2007;3:249–51.
Daróczy J. Antiseptic efficacy of local disinfecting povidone iodine (Betadine) therapy in chronic wounds of lymphedematous patients. Dermatology. 2002;204:75–8.
Tilley S. Use of laser therapy in the management of lymphoedema. J Lymphoedema. 2009;4(1):39–43.
Hawkins D, Abrahamse H. Effect of multiple exposures of low-level laser therapy on the cellular responses of wounded human skin fibroblasts. Photomed Laser Surg. 2006;24(6):705–14.
Owens DK, Lohr KN, Atkins D, et al. Grading the strength of a body of evidence when comparing medical interventions. In: Agency for healthcare research and quality. Methods guide for comparative effectiveness reviews [posted July 2009]. Rockville, MD. Available at: http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=rr&ProcessID=60.
OCEBM Levels of Evidence Working Group*. The Oxford levels of evidence 2. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653. *OCEBM Levels of Evidence Working Group=Jeremy Howick, Iain Chalmers (James Lind Library), Paul Glasziou, Trish Greenhalgh, Carl Heneghan, Alessandro Liberati, Ivan Moschetti, Bob Phillips, Hazel Thornton, Olive Goddard and Mary Hodgkinson.
Cohen J. Statistical power analysis. Curr Dir Psychol Sci. 1992;1(3):98–101.
The authors wish to thank Felicia F. Ferlin, PT, DPT, and Victoria Deguzman, PT, DPT, for their review and critique of this manuscript. Dr. Smoot is partially supported by the Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) K12, Grant Number K12HD052163 NICHD/NIH, and by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number KL2TR000143.
Conflict of interest
The authors declare no financial conflicts of interest.
About this article
Cite this article
Smoot, B., Chiavola-Larson, L., Lee, J. et al. Effect of low-level laser therapy on pain and swelling in women with breast cancer-related lymphedema: a systematic review and meta-analysis. J Cancer Surviv 9, 287–304 (2015). https://doi.org/10.1007/s11764-014-0411-1
- Breast cancer
- Low-level laser therapy