Abstract
Background
Lymphedema treatment is based on an intensive decongestive physiotherapy phase of volume reduction followed by a long-term maintenance phase. Factors influencing the morbid lymphedema volume increase during maintenance were analyzed.
Materials and methods
Among 867 consecutive women recruited and followed in a single lymphology unit, 682 were analyzed. The other 185 were not analyzed because of an initial lymphedema volume <250 ml, <20% lymphedema volume decrease during the intensive phase, or they were lost to follow-up. Lymphedema volume was recorded prior to and at the end of intensive phase, and at each follow-up visit. During follow-up, treatment failure was defined as a lymphedema volume increase of ≥50% of the total reduction obtained during the intensive phase.
Results
Median lymphedema volume was 936 ml before and 335 ml after intensive decongestive physiotherapy (P < 0.0001). Median follow-up was 28 months. During the maintenance phase, the risk of treatment failure at 1, 2, and 4 years was estimated to be 38.1%, 53.1%, and 64.8%, respectively. Wearing an elastic sleeve during the day and an overnight multilayer low-stretch bandage (median, four nights per week; interquartile range, 2–6) significantly decreased the risk of treatment failure [hazard ratio, 0.53, (0.34–0.82), P = 0.004], whereas manual lymph drainage adjunction to those therapeutic components did not. The risk of treatment failure was also associated with weight and body mass index at inclusion.
Conclusion
Risk of maintenance-therapy failure after intensive decongestive physiotherapy was associated with patients characteristics (younger age, higher weight, and body mass index), while elastic sleeve and bandage were associated with better maintenance results. Paradoxical effect of manual lymph drainage is likely to be related to indication bias.
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References
Lucci A, McCall LM, Beitsch PD et al (2007) Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol 25:3657–3663
Langer I, Guller U, Berclaz G et al (2007) Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg 245:452–461
McLaughlin SA, Wright MJ, Morris KT et al (2008) Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol 26:5213–5219
Heiney SP, McWayne J, Cunningham JE et al (2007) Quality of life and lymphedema following breast cancer. Lymphology 40:177–184
Harris SR, Hugi MR, Olivotto IA, Levine M, Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer (2001) Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema. CMAJ 164:191–199
Lymphoedema Framework (2006) Best practice for the management of lymphoedema. International consensus. MEP Ltd, London
Cheville AL, McGarvey CL, Petrek JA et al (2003) Lymphedema management. Semin Radiat Oncol 13:290–301
Szuba A, Cooke JP, Yousuf S, Rockson SG (2000) Decongestive lymphatic therapy for patients with cancer-related or primary lymphedema. Am J Med 109:296–300
Ko DS, Lerner R, Klose G, Cosimi AB (1998) Effective treatment of lymphedema of the extremities. Arch Surg 133:452–458
Shaw C, Mortimer P, Judd PA (2007) A randomized controlled trial of weight reduction as a treatment for breast cancer-related lymphedema. Cancer 110:1868–1874
Sitzia J (1995) Volume measurement in lymphoedema treatment: examination of formulae. Eur J Cancer Care 4:11–16
Galland C, Auvert JF, Flahault A, Vayssairat M (2002) Why and how post-mastectomy edema should be quantified in patients with breast cancer. Breast Cancer Res Treat 75:87–89
Boris M, Weindorf S, Lasinski B (1997) Persistence of lymphedema reduction after noninvasive complex lymphedema therapy. Oncology (Williston Park) 11:99–109, discussion 110, 113–114
Vignes S, Porcher R, Arrault M, Dupuy A (2007) Long-term management of breast cancer-related lymphedema after intensive decongestive physiotherapy. Breast Cancer Res Treat 101:285–29
Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A et al (2010) Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. BMJ 340:b5396. doi:10.1136/bmj.b5396
Kocak Z, Overgaard J (2000) Risk factors of arm lymphedema in breast cancer patients. Acta Oncol 39:389–392
Petrek JA, Senie RT, Peters M, Rosen PP (2001) Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer 92:1368–1377
Vignes S, Arrault M, Dupuy A (2007) Factors associated with increased breast cancer-related lymphedema volume. Acta Oncol 46:1138–1142
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Vignes, S., Porcher, R., Arrault, M. et al. Factors influencing breast cancer-related lymphedema volume after intensive decongestive physiotherapy. Support Care Cancer 19, 935–940 (2011). https://doi.org/10.1007/s00520-010-0906-x
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DOI: https://doi.org/10.1007/s00520-010-0906-x