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Li D, Liu S, Yu T, Liu Z, Sun S, Bragin D, Shirokov A, Navolokin N, Bragina O, Hu Z, Kurths J, Fedosov I, Blokhina I, Dubrovski A, Khorovodov A, Terskov A, Tzoy M, Semyachkina-Glushkovskaya O, Zhu D. Photostimulation of brain lymphatics in male newborn and adult rodents for therapy of intraventricular hemorrhage. Nat Commun 2023; 14:6104. [PMID: 37775549 PMCID: PMC10541888 DOI: 10.1038/s41467-023-41710-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 09/15/2023] [Indexed: 10/01/2023] Open
Abstract
Intraventricular hemorrhage is one of the most fatal forms of brain injury that is a common complication of premature infants. However, the therapy of this type of hemorrhage is limited, and new strategies are needed to reduce hematoma expansion. Here we show that the meningeal lymphatics is a pathway to remove red blood cells from the brain's ventricular system of male human, adult and newborn rodents and is a target for non-invasive transcranial near infrared photobiomodulation. Our results uncover the clinical significance of phototherapy of intraventricular hemorrhage in 4-day old male rat pups that have the brain similar to a preterm human brain. The course of phototherapy in newborn rats provides fast recovery after intraventricular hemorrhage due to photo-improvements of lymphatic drainage and clearing functions. These findings shed light on the mechanisms of phototherapy of intraventricular hemorrhage that can be a clinically relevant technology for treatment of neonatal intracerebral bleedings.
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Affiliation(s)
- Dongyu Li
- Britton Chance Center for Biomedical Photonics - MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics - Advanced Biomedical Imaging Facility, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
- School of Optical Electronic Information, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
| | - Shaojun Liu
- Britton Chance Center for Biomedical Photonics - MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics - Advanced Biomedical Imaging Facility, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
| | - Tingting Yu
- Britton Chance Center for Biomedical Photonics - MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics - Advanced Biomedical Imaging Facility, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China.
| | - Zhang Liu
- Britton Chance Center for Biomedical Photonics - MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics - Advanced Biomedical Imaging Facility, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
| | - Silin Sun
- Britton Chance Center for Biomedical Photonics - MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics - Advanced Biomedical Imaging Facility, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
| | - Denis Bragin
- Lovelace Biomedical Research Institute, Albuquerque, NM, 87108, USA
- Department of Neurology University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA
| | - Alexander Shirokov
- Institute of Biochemistry and Physiology of Plants and Microorganisms, Russian Academy of Sciences, Prospekt Entuziastov 13, Saratov, 410049, Russia
- Saratov State University, Astrakhanskaya str., 83, Saratov, 410012, Russia
| | - Nikita Navolokin
- Saratov State University, Astrakhanskaya str., 83, Saratov, 410012, Russia
- Saratov State Medical University, B. Kazachya str., 112, Saratov, 410012, Russia
| | - Olga Bragina
- Lovelace Biomedical Research Institute, Albuquerque, NM, 87108, USA
| | - Zhengwu Hu
- Britton Chance Center for Biomedical Photonics - MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics - Advanced Biomedical Imaging Facility, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
- School of Optical Electronic Information, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China
| | - Jürgen Kurths
- Saratov State University, Astrakhanskaya str., 83, Saratov, 410012, Russia
- Physics Department, Humboldt University, Newtonstrasse 15, 12489, Berlin, Germany
- Potsdam Institute for Climate Impact Research, Telegrafenberg A31, 14473, Potsdam, Germany
- Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya 2, building 4, 119435, Moscow, Russia
| | - Ivan Fedosov
- Saratov State University, Astrakhanskaya str., 83, Saratov, 410012, Russia
| | - Inna Blokhina
- Saratov State University, Astrakhanskaya str., 83, Saratov, 410012, Russia
| | | | | | - Andrey Terskov
- Saratov State University, Astrakhanskaya str., 83, Saratov, 410012, Russia
| | - Maria Tzoy
- Saratov State University, Astrakhanskaya str., 83, Saratov, 410012, Russia
| | - Oxana Semyachkina-Glushkovskaya
- Saratov State University, Astrakhanskaya str., 83, Saratov, 410012, Russia.
- Physics Department, Humboldt University, Newtonstrasse 15, 12489, Berlin, Germany.
| | - Dan Zhu
- Britton Chance Center for Biomedical Photonics - MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics - Advanced Biomedical Imaging Facility, Huazhong University of Science and Technology, 430074, Wuhan, Hubei, China.
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Farhan F, Samei M, Abdshah A, Kazemian A, Shahriarian S, Amouzegar‐Hashemi F, Farzin M, Ghalehtaki R, Jafari F, Cuccia F. Investigation of the effect of Low-Level Laser Therapy on arm lymphedema in breast cancer patients: A noninvasive treatment for an intractable morbidity. Health Sci Rep 2023; 6:e1261. [PMID: 37205934 PMCID: PMC10189865 DOI: 10.1002/hsr2.1261] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/10/2023] [Accepted: 04/29/2023] [Indexed: 05/21/2023] Open
Abstract
Purpose This article aims to study the effect of Low-Level Laser Therapy (LLLT) on arm lymphedema in patients who have breast cancer. Methods and Materials Twenty-three patients were selected in a nonrandomized phase-2 clinical trial. After measuring the circumference of the affected and unaffected limbs at 6-points, the volume of the limbs, the degree of mental symptoms on visual analog scale by the patient upon entering the study, and performing an ultrasound on the patient's axilla to locate the fibrotic areas, a low-level laser device at a therapeutic dose of 2 J/cm2 was used to treat the patients three times a week for 4 weeks, and after an 8-week gap, for another similar period. Measurement of circumference and volume of affected and unaffected limbs and mental symptoms were carried out at the end of the 4th week, the beginning of the 12th week, and the end of the 16th week, and the obtained results were compared with those before the treatment. Results We noted that the average reductions in the circumference and volume of the affected limb, as compared with the unaffected limb, were about 16% and 21.7%, respectively, and improvement in the patient's mental symptoms was about 32%. Another notable observation was the great enthusiasm of most patients to continue their treatment, particularly from the second cycle onward. Conclusions LLLT can, at least in association with current standard methods, be used for arm lymphedema to introduce further reductions in pain and volume.
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Affiliation(s)
- Farshid Farhan
- Radiation Oncology Research Center (RORC), Cancer InstituteTehran University of Medical SciencesTehranIran
| | - Mahmood Samei
- Radiation Oncology Research Center (RORC), Cancer InstituteTehran University of Medical SciencesTehranIran
| | - Alireza Abdshah
- School of MedicineTehran University of Medical SciencesTehranIran
- Department of Public Health SciencesDivision of Biostatistics, University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Ali Kazemian
- Radiation Oncology Research Center (RORC), Cancer InstituteTehran University of Medical SciencesTehranIran
| | - Shahriar Shahriarian
- Department of Radiology, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Farnaz Amouzegar‐Hashemi
- Radiation Oncology Research Center (RORC), Cancer InstituteTehran University of Medical SciencesTehranIran
| | - Mostafa Farzin
- Brain and spinal cord injury research center, Neuroscience InstituteTehran University of Medical SciencesTehranIran
| | - Reza Ghalehtaki
- Radiation Oncology Research Center (RORC), Cancer InstituteTehran University of Medical SciencesTehranIran
| | - Fatemeh Jafari
- Radiation Oncology Research Center (RORC), Cancer InstituteTehran University of Medical SciencesTehranIran
- Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Francesco Cuccia
- Advanced Radiation Oncology DepartmentSacro Cuore Don Calabria HospitalNegrarVenetoItaly
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Rezende LFD, Da Silva Costa EC, Lenzi J, Carvalho RL, Vilas Boas VF. Transcutaneous Electrical Stimulation, Interferential Current and Photobiomodulation May Lead to the Recurrence of Breast Cancer in Rats? REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n3.2383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Introduction: Transcutaneous electrical nerve stimulation (TENS), interferential current therapy (IFC) and photobiomodulation therapy (PBMT) have been used in the management of cancer-related pain in adults. However, there are still some controversy regarding the effects of this therapy on tumor cells that may remain after cancer treatment. Objective: To evaluate the risk of recurrence of breast cancer in rats when using TENS, IFC or PBMT. Method: An experimental, randomized, controlled and cross-sectional study. With 90 days of age, 7,12-dimetylbenz(a)anthracene (7,12-DMBA) was administered to rats by gastric gavage to induce mammary cancer. After 120 days the mammary glands of the rats belonging to the group with mammary cancer were removed. Results: 39 female Sprague-Dawley rats were studied: 9 rats without induction of mammary carcinoma; 9 rats with induction of mammary carcinoma and without surgery; 9 rats with induction of mammary carcinoma with surgery and placebo application of TENS, IFC, PBMT; 9 rats with induction of mammary carcinoma, surgery and the application of TENS, IFC and PBMT. Conclusion: This study demonstrated that there was local recurrence of tumors in rats that were stimulated with TENS or IFC, however no evidence of local recurrence with PBMT.
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Wang Y, Ge Y, Xing W, Liu J, Wu J, Lin H, Lu Y. The effectiveness and safety of low-level laser therapy on breast cancer-related lymphedema: An overview and update of systematic reviews. Lasers Med Sci 2021; 37:1389-1413. [PMID: 34779937 PMCID: PMC8971164 DOI: 10.1007/s10103-021-03446-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022]
Abstract
The objective of our overview of systematic reviews was to critically analyze the evidence from existing systematic reviews investigating the effectiveness and safety of low-level laser therapy (LLLT) in patients with breast cancer–related lymphedema (BCRL). In addition, an updated and comprehensive systematic review was conducted, which aimed to provide updated evidence about this topic. PubMed, EMBASE, and Cochrane Library databases were systematically searched for systematic reviews and randomized controlled trials (RCTs) investigating the effectiveness and safety of LLLT in patients with BCRL. The methodological quality for each of included systematic reviews or RCTs was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) tool or Cochrane risk of bias tool, respectively. The updated systematic review separately compared the effectiveness of LLLT to each of active or negative interventions. Data were pooled with random-effects models for each outcome per comparison. The evidence quality of outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) or GRADE-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) for quantitative studies and qualitative studies, respectively. Seven systematic reviews and ten RCTs met the eligibility criteria. Conflicting results regarding the effectiveness of LLLT were presented by the overview of systematic reviews. The AMSTAR 2 showed that the methodological quality of included systematic reviews was low or critically low quality due to one or more critical weaknesses. The GRADE and GRADE-CERQual showed that the evidence quality was low to very low for most outcomes. The updated systematic review showed that LLLT may offer additional benefits as compared to compression therapies (pneumatic compression or compression bandage), placebo laser, or no treatment for patients with BCRL. However, when compared to other types of active interventions, LLLT did not improve outcomes significantly. None of the treatment-related adverse event was reported. Many trials had a high or unclear risk of bias for two or more items, and our updated systematic review showed low quality of evidence per outcome using GRADE approach. Due to insufficient data and poor quality of evidence, there is uncertain to reach these conclusions that LLLT is superior to another active or negative intervention and is safe. More RCTs of high methodological quality, with large sample sizes and long-term follow-up, are needed to inform clinical guidelines and routine practice.
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Affiliation(s)
- Yuping Wang
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China
| | - Yonggui Ge
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China
| | - Wenting Xing
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China
| | - Junping Liu
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China
| | - Jiqi Wu
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China
| | - Haijuan Lin
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China
| | - Yaqin Lu
- Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China.
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Robijns J, Lodewijckx J, Claes S, Van Bever L, Pannekoeke L, Censabella S, Bussé L, Colson D, Kaminski I, Broux V, Puts S, Vanmechelen S, Timmermans A, Noé L, Bulens P, Govers M, Maes A, Mebis J. Photobiomodulation therapy for the prevention of acute radiation dermatitis in head and neck cancer patients (DERMISHEAD trial). Radiother Oncol 2021; 158:268-275. [DOI: 10.1016/j.radonc.2021.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 12/25/2022]
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Kozanoglu E, Gokcen N, Basaran S, Paydas S. Long-Term Effectiveness of Combined Intermittent Pneumatic Compression Plus Low-Level Laser Therapy in Patients with Postmastectomy Lymphedema: A Randomized Controlled Trial. Lymphat Res Biol 2021; 20:175-184. [PMID: 33826415 DOI: 10.1089/lrb.2020.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Upper limb lymphedema may be revealed after breast cancer and its treatment. Among different treatment approaches, intermittent pneumatic compression (IPC) therapy and low-level laser therapy (LLLT) are reported as effective modalities in the treatment of postmastectomy upper limb lymphedema (PML). The aim of the current study is to investigate the long-term effectiveness of combined IPC plus LLLT versus IPC therapy alone in patients with PML. Methods and Results: The patients were allocated into two groups in this single-blinded, controlled clinical trial. Group I received combined treatment with IPC plus LLLT (n = 21) and group II received only IPC (n = 21). IPC treatment was given 5 sessions per week for 4 weeks (20 sessions). LLLT was also performed 5 sessions per week for 4 weeks (20 sessions). Clinical evaluations were performed before and after the treatment at the 3, 6, and 12-month follow-up visits. According to within-group analysis, statistically significant improvements in the circumference difference (Cdiff) and grip strength were observed in both groups (for Cdiff, p = 0.018 and p = 0.032, respectively; for grip strength, p = 0.001 and p = 0.046, respectively). Visual analog scale values for arm pain and shoulder pain during motion were decreased only in group I. Conclusion: Both interventions have positive effects on lymphedema, grip strength, and pain. Long-term effects of combined therapy, especially on pain, are slightly superior to the pneumatic compression alone.
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Affiliation(s)
- Erkan Kozanoglu
- Department of Physical Medicine and Rehabilitation, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Neslihan Gokcen
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Sibel Basaran
- Department of Physical Medicine and Rehabilitation, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Semra Paydas
- Division of Oncology, Department of Internal Medicine, Cukurova University Faculty of Medicine, Adana, Turkey
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Lang AE, Kim SY, Dickerson CR, Milosavljevic S. Measurement of objective shoulder function following breast cancer surgery: a scoping review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1851439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Angelica E. Lang
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Soo Y. Kim
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
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Akgul A, Tarakci E, Arman N, Civi T, Irmak S. A Randomized Controlled Trial Comparing Platelet-Rich Plasma, Low-Level Laser Therapy, and Complex Decongestive Physiotherapy in Patients with Lower Limb Lymphedema. Lymphat Res Biol 2020; 18:439-447. [DOI: 10.1089/lrb.2019.0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Ahmet Akgul
- Division of Gerontology, Faculty of Health Sciences, Istanbul University Cerrahpaşa, Istanbul, Turkey
- Ist-GETAM, Center of Gerontechnology, Istanbul University Cerrahpaşa, Istanbul, Turkey
- Division of Cardiovascular Surgery, Bakirköy Education and Research Hospital, Istanbul, Turkey
| | - Ela Tarakci
- Ist-GETAM, Center of Gerontechnology, Istanbul University Cerrahpaşa, Istanbul, Turkey
- Division of Physiotherapy and Rehabilitation, Department of Neurologic Physiotherapy and Rehabilitation, Faculty of Health Science, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Nilay Arman
- Ist-GETAM, Center of Gerontechnology, Istanbul University Cerrahpaşa, Istanbul, Turkey
- Division of Physiotherapy and Rehabilitation, Department of Neurologic Physiotherapy and Rehabilitation, Faculty of Health Science, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Tugba Civi
- Ist-GETAM, Center of Gerontechnology, Istanbul University Cerrahpaşa, Istanbul, Turkey
- Division of Physiotherapy and Rehabilitation, Department of Neurologic Physiotherapy and Rehabilitation, Faculty of Health Science, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | - Selin Irmak
- Division of Gerontology, Faculty of Health Sciences, Istanbul University Cerrahpaşa, Istanbul, Turkey
- Ist-GETAM, Center of Gerontechnology, Istanbul University Cerrahpaşa, Istanbul, Turkey
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Kilmartin L, Denham T, Fu MR, Yu G, Kuo TT, Axelrod D, Guth AA. Complementary low-level laser therapy for breast cancer-related lymphedema: a pilot, double-blind, randomized, placebo-controlled study. Lasers Med Sci 2019; 35:95-105. [DOI: 10.1007/s10103-019-02798-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022]
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Baxter GD, Liu L, Tumilty S, Petrich S, Chapple C, Anders JJ. Low level laser therapy for the management of breast cancer-related lymphedema: A randomized controlled feasibility study. Lasers Surg Med 2018; 50:924-932. [DOI: 10.1002/lsm.22947] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 11/12/2022]
Affiliation(s)
- George David Baxter
- Centre for Health, Activity and Rehabilitation Research; School of Physiotherapy, University of Otago; Dunedin New Zealand
| | - Lizhou Liu
- Centre for Health, Activity and Rehabilitation Research; School of Physiotherapy, University of Otago; Dunedin New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research; School of Physiotherapy, University of Otago; Dunedin New Zealand
| | - Simone Petrich
- Department of Surgical Sciences; Southern District Health Board; Dunedin New Zealand
| | - Cathy Chapple
- Centre for Health, Activity and Rehabilitation Research; School of Physiotherapy, University of Otago; Dunedin New Zealand
| | - Juanita J. Anders
- Department of Anatomy, Physiology and Genetics; Uniformed Services University of the Health Sciences; Bethesda Maryland
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12
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Using Low-Level Light Laser in Your Lymphedema Practice: Benefits and Cautions. REHABILITATION ONCOLOGY 2018. [DOI: 10.1097/01.reo.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Baxter GD, Liu L, Petrich S, Gisselman AS, Chapple C, Anders JJ, Tumilty S. Low level laser therapy (Photobiomodulation therapy) for breast cancer-related lymphedema: a systematic review. BMC Cancer 2017; 17:833. [PMID: 29216916 DOI: 10.1186/s12885-017-3852-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 11/28/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Breast cancer related lymphedema (BCRL) is a prevalent complication secondary to cancer treatments which significantly impacts the physical and psychological health of breast cancer survivors. Previous research shows increasing use of low level laser therapy (LLLT), now commonly referred to as photobiomodulation (PBM) therapy, for BCRL. This systematic review evaluated the effectiveness of LLLT (PBM) in the management of BCRL. METHODS Clinical trials were searched in PubMed, AMED, Web of Science, and China National Knowledge Infrastructure up to November 2016. Two reviewers independently assessed the methodological quality and adequacy of LLLT (PBM) in these clinical trials. Primary outcome measures were limb circumference/volume, and secondary outcomes included pain intensity and range of motion. Because data were clinically heterogeneous, best evidence synthesis was performed. RESULTS Eleven clinical trials were identified, of which seven randomized controlled trials (RCTs) were chosen for analysis. Overall, the methodological quality of included RCTs was high, whereas the reporting of treatment parameters was poor. Results indicated that there is strong evidence (three high quality trials) showing LLLT (PBM) was more effective than sham treatment for limb circumference/volume reduction at a short-term follow-up. There is moderate evidence (one high quality trial) indicating that LLLT (PBM) was more effective than sham laser for short-term pain relief, and limited evidence (one low quality trial) that LLLT (PBM) was more effective than no treatment for decreasing limb swelling at short-term follow-up. CONCLUSIONS Based upon the current systematic review, LLLT (PBM) may be considered an effective treatment approach for women with BCRL. Due to the limited numbers of published trials available, there is a clear need for well-designed high-quality trials in this area. The optimal treatment parameters for clinical application have yet to be elucidated.
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Affiliation(s)
- G David Baxter
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - Lizhou Liu
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Simone Petrich
- Department of Surgical Sciences, Southern District Health Board, Dunedin, New Zealand
| | - Angela Spontelli Gisselman
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Cathy Chapple
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Juanita J Anders
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Maryland, MD, USA
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Hamblin MR. Photobiomodulation for traumatic brain injury and stroke. J Neurosci Res 2017; 96:731-743. [PMID: 29131369 DOI: 10.1002/jnr.24190] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 10/04/2017] [Accepted: 10/04/2017] [Indexed: 12/12/2022]
Abstract
There is a notable lack of therapeutic alternatives for what is fast becoming a global epidemic of traumatic brain injury (TBI). Photobiomodulation (PBM) employs red or near-infrared (NIR) light (600-1100nm) to stimulate healing, protect tissue from dying, increase mitochondrial function, improve blood flow, and tissue oxygenation. PBM can also act to reduce swelling, increase antioxidants, decrease inflammation, protect against apoptosis, and modulate microglial activation state. All these mechanisms of action strongly suggest that PBM delivered to the head should be beneficial in cases of both acute and chronic TBI. Most reports have used NIR light either from lasers or from light-emitting diodes (LEDs). Many studies in small animal models of acute TBI have found positive effects on neurological function, learning and memory, and reduced inflammation and cell death in the brain. There is evidence that PBM can help the brain repair itself by stimulating neurogenesis, upregulating BDNF synthesis, and encouraging synaptogenesis. In healthy human volunteers (including students and healthy elderly women), PBM has been shown to increase regional cerebral blood flow, tissue oxygenation, and improve memory, mood, and cognitive function. Clinical studies have been conducted in patients suffering from the chronic effects of TBI. There have been reports showing improvement in executive function, working memory, and sleep. Functional magnetic resonance imaging has shown modulation of activation in intrinsic brain networks likely to be damaged in TBI (default mode network and salience network).
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Affiliation(s)
- Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA.,Department of Dermatology, Harvard Medical School, Boston, MA.,Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA
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Kayıran O, De La Cruz C, Tane K, Soran A. Lymphedema: From diagnosis to treatment. Turk J Surg 2017; 33:51-57. [PMID: 28740950 DOI: 10.5152/turkjsurg.2017.3870] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 03/20/2017] [Indexed: 02/03/2023]
Abstract
Lymphedema is a chronic and progressive disorder resulting from impaired lymphatic system function. In developed countries, upper extremity lymphedema is mainly the consequence of breast cancer surgery in which axillary lymph node dissection and radiation alter upper extremity lymphatic flow. Diagnosis of lymphedema is made clinically. Nevertheless, there are numerous diagnostic tools available for disease staging. Recently, a new technology namely magnetic resonance lymphangiography has emerged in the medical field to assist in both diagnosis and management. There are non-surgical and surgical treatment options available. Non-surgical methods are always the first-line treatment; however, surgical options can be explored in appropriate patients. Recent studies focus on the prevention of lymphedema using surgical techniques utilizing axillary reverse mapping to delineate arm lymphatics from axillary lymphatics. Finding the most suitable technique for each type of lymphedema with variable stages is one of the most complicated decisions for practitioners. More studies are needed to reveal the exact biology of lymphedema to ensure complete understanding of the disease and improve outcomes.
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Affiliation(s)
- Oğuz Kayıran
- Division of Breast Surgery and Lymphedema Program, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, USA.,Department of Plastic and Reconstructive Surgery, Baltalimani Hospital, İstanbul, Turkey
| | - Carolyn De La Cruz
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Kaori Tane
- Division of Breast Surgery and Lymphedema Program, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Atilla Soran
- Division of Breast Surgery and Lymphedema Program, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, USA
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16
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Storz MA, Gronwald B, Gottschling S, Schöpe J, Mavrova R, Baum S. Photobiomodulation therapy in breast cancer-related lymphedema: a randomized placebo-controlled trial. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017; 33:32-40. [DOI: 10.1111/phpp.12284] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/02/2016] [Indexed: 12/12/2022]
Affiliation(s)
| | - Benjamin Gronwald
- Centre of Palliative Care and Pediatric Pain; The Saarland University Hospital; Homburg Germany
| | - Sven Gottschling
- Centre of Palliative Care and Pediatric Pain; The Saarland University Hospital; Homburg Germany
| | - Jakob Schöpe
- Institute for Medical Biometry, Epidemiology and Medical Informatics; The Saarland University; Homburg Germany
| | - Russalina Mavrova
- Department of Gynecology and Obstetrics; The Saarland University Hospital; Homburg Germany
| | - Sascha Baum
- Department of Gynecology and Obstetrics; The Saarland University Hospital; Homburg Germany
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17
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Robijns J, Censabella S, Bulens P, Maes A, Mebis J. The use of low-level light therapy in supportive care for patients with breast cancer: review of the literature. Lasers Med Sci 2016; 32:229-242. [DOI: 10.1007/s10103-016-2056-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 08/12/2016] [Indexed: 12/11/2022]
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18
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Zecha JAEM, Raber-Durlacher JE, Nair RG, Epstein JB, Elad S, Hamblin MR, Barasch A, Migliorati CA, Milstein DMJ, Genot MT, Lansaat L, van der Brink R, Arnabat-Dominguez J, van der Molen L, Jacobi I, van Diessen J, de Lange J, Smeele LE, Schubert MM, Bensadoun RJ. Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols. Support Care Cancer 2016; 24:2793-805. [PMID: 26984249 DOI: 10.1007/s00520-016-3153-y] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 03/07/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved and dosimetric parameters may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are discussed. METHODS Narrative review and presentation of PBM parameters are based on current evidence and expert opinion. RESULTS PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy (CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength, typically between 633 and 685 nm or 780-830 nm; energy density, laser or light-emitting diode (LED) output between 10 and 150 mW; dose, 2-3 J (J/cm(2)), and no more than 6 J/cm(2) on the tissue surface treated; treatment schedule, two to three times a week up to daily; emission type, pulsed (<100 Hz); and route of delivery, intraorally and/or transcutaneously. To facilitate further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations. CONCLUSION PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC with CRT. The suggested PBM irradiation and dosimetric parameters, which are potentially effective for these complications, are intended to provide guidance for well-designed future studies. It is imperative that such studies include elucidating the effects of PBM on oncology treatment outcomes.
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Affiliation(s)
- Judith A E M Zecha
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Judith E Raber-Durlacher
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Department of Medical Dental Interaction and Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, P.O. Box 22660 1100 DD, Amsterdam, the Netherlands
| | - Raj G Nair
- Oral Medicine Oral Pathology and Human Diseases, Menzies Health Institute Queensland and Oral Medicine Consultant, Department of Haematology and Oncology/Cancer Services, Gold Coast University Hospital, Queensland Health, Queensland, Australia
| | - Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA, 91010, USA
| | - Sharon Elad
- Division of Oral Medicine, Eastman Institute for Oral Health, and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, 14620, USA
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Dermatology, Harvard Medical School, Boston, MA, 02115, USA.,Harvard-MIT Division of Health Science and Technology, Cambridge, MA, 02139, USA
| | - Andrei Barasch
- Division of Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - Cesar A Migliorati
- Department of Diagnostic Sciences and Oral Medicine, Director of Oral Medicine, College of Dentistry, University of Tennessee Health Science Center, 875 Union Ave. Suite N231, Memphis, TN, 38163, USA
| | - Dan M J Milstein
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Marie-Thérèse Genot
- Laser Therapy Unit, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Brussels, Belgium
| | - Liset Lansaat
- Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ron van der Brink
- Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA, 91010, USA
| | | | - Lisette van der Molen
- Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Irene Jacobi
- Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Judi van Diessen
- Antoni van Leeuwenhoek Department of Radiation Oncology, Amsterdam, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mark M Schubert
- Seattle Cancer Care Alliance (SCCA), Oral Medicine, 825 Eastlake Ave E Ste G6900, Seattle, WA, 98109, USA
| | - René-Jean Bensadoun
- World Association for Laser Therapy (WALT) Scientific Secretary, Centre de Haute Energie (CHE), 10 Bd Pasteur, 06000, Nice, France.
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Hwang WT, Chung SH, Kim H. Low-level laser therapy for the treatment of superficial thrombophlebitis after chemotherapy in breast cancer patients: a case study. J Phys Ther Sci 2015; 27:3937-8. [PMID: 26834384 PMCID: PMC4713823 DOI: 10.1589/jpts.27.3937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/17/2015] [Indexed: 11/25/2022] Open
Abstract
[Purpose] We report the case of a breast cancer patient with superficial thrombophlebitis treated with low-level laser therapy. [Case] The patient was a 66-year-old women who developed superficial thrombophlebitis in the left upper limb after chemotherapy. She was administered 6 sessions of low-level laser therapy. [Result] Her pain score decreased by 8 points. Her scores on the Patient and Observer scar Assessment Scale decreased by 18 points for the observer portion and by 26 points for the patient portion. [Conclusion] Low-level laser therapy is effective for the reduction of pain and the size of scar tissue in patients with superficial thrombophlebitis.
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Affiliation(s)
- Woon Taek Hwang
- Department of Physical Medicine and Rehabilitation
Medicine, Hanyang University Medical Center, Republic of Korea
| | - Sin Ho Chung
- Department of Physical Medicine and Rehabilitation
Medicine, Hanyang University Medical Center, Republic of Korea
| | - Hyunhee Kim
- Department of Physical Therapy, Shinsung University: 1
Daehack-ro, Jeongmi-myeon, Dangjin-si, Chungcheongnam-do, Republic of Korea
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20
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Fu MR, Deng J, Armer JM. Putting evidence into practice: cancer-related lymphedema. Clin J Oncol Nurs 2015; 18 Suppl:68-79. [PMID: 25427610 DOI: 10.1188/14.cjon.s3.68-79] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer-related lymphedema is a progressive and chronic syndrome of abnormal swelling and multiple symptoms resulting from cancer treatment. Even with modern medical advances, lymphedema remains a major health problem affecting thousands of cancer survivors. To provide healthcare professionals with evidence-based clinical practice guidelines for lymphedema treatment and management, a systematic review was conducted to evaluate 75 selected articles from 2009-2014 by the Oncology Nursing Society Putting Evidence Into Practice lymphedema team. Findings of the systematic review support complete decongestive therapy, compression bandages, and compression garments with highest evidence for best clinical practice. Weight management, full-body exercise, information provision, prevention, and early intervention protocols are likely to be effective for clinical practice. Historic recommendations for activity restriction and avoidance of aerobic and resistive exercises that limit cancer survivors' daily lives have been challenged with more evidence. Cancer survivors may not need to restrict activities such as resistive or aerobic exercises and weightlifting with gradual exercise progression. Future research should focus on providing high-level evidence using randomized clinical trials with larger samples and studying lymphedema beyond breast cancer.
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Affiliation(s)
- Mei R Fu
- College of Nursing, New York University, New York
| | - Jie Deng
- School of Nursing, Vanderbilt University, Nashville, TN
| | - Jane M Armer
- School of Nursing, University of Missouri, Columbia
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In vitro study on the safety of near infrared laser therapy in its potential application as postmastectomy lymphedema treatment. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2015; 151:285-96. [PMID: 26355716 DOI: 10.1016/j.jphotobiol.2015.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 07/29/2015] [Accepted: 08/11/2015] [Indexed: 12/18/2022]
Abstract
Clinical studies demonstrated the effectiveness of laser therapy in the management of postmastectomy lymphedema, a discomforting disease that can arise after surgery/radiotherapy and gets progressively worse and chronic. However, safety issues restrict the possibility to treat cancer patients with laser therapy, since the effects of laser radiation on cancer cell behavior are not completely known and the possibility of activating postmastectomy residual cancer cells must be considered. This paper reports the results of an in vitro study aimed to investigate the effect of a class IV, dual-wavelength (808 nm and 905 nm), NIR laser system on the behavior of two human breast adenocarcinoma cell lines (namely, MCF7 and MDA-MB361 cell lines), using human dermal fibroblasts as normal control. Cell viability, proliferation, apoptosis, cell cycle and ability to form colonies were analyzed in order to perform a cell-based safety testing of the laser treatment in view of its potential application in the management of postmastectomy lymphedema. The results showed that, limited to the laser source, treatment conditions and experimental models used, laser radiation did not significantly affect the behavior of human breast adenocarcinoma cells, including their clonogenic efficiency. Although these results do not show any significant laser-induced modification of cancer cell behavior, further studies are needed to assess the possibility of safely applying NIR laser therapy for the management of postmastectomy lymphedema.
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22
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Monteiro SE, Resende LV, Felicíssimo MF, Araújo ARD, Vaz CT. Treatment of upper limb lymphedema with low-level laser: a systematic review. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.004.ar01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Low-level lasers have been suggested as a complement to lymphedema treatment. However, this therapy’s mechanism of action and its effects are poorly understood up to the present. Objective To conduct a systematic literature review to analyze the effects of low-level laser in the treatment of upper-limb lymphedema in women submitted to breast cancer surgery. Material and methods Randomized clinical trials were included, in Portuguese, English and Spanish, from January 1990 to July 2013. The article search was carried out in the Pubmed, Lilacs and PEDro electronic databases, with the following descriptors:Terapia a Laser de Baixa Intensidade, Linfedema, Câncer de Mama, Low-level laser therapy, Lymphedema, Breast Neoplasms and also through a manual search. Results and discussion Low-level lasers have been used for treating several acute and chronic conditions. However, its application for managing post breast cancer surgery is still recent, often based on empirical evidence. Treating upper-limb lymphedema with low-level laser presented positive results, with reduction in the circumference or volume of the affected limb. Conclusion More studies of high methodological quality are needed in order to better understand the mechanism of action of low-level laser on the lymphatic system and its effects on lymphedema treatement.
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Smoot B, Chiavola-Larson L, Lee J, Manibusan H, Allen DD. 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 2014; 9:287-304. [PMID: 25432632 DOI: 10.1007/s11764-014-0411-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE 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). METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Betty Smoot
- Graduate Program in Physical Therapy, University of California San Francisco/San Francisco State University, San Francisco, CA, USA,
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Costa MM, Silva SB, Quinto ALP, Pasquinelli PFS, de Queiroz dos Santos V, de Cássia Santos G, Veiga DF. Phototherapy 660 nm for the prevention of radiodermatitis in breast cancer patients receiving radiation therapy: study protocol for a randomized controlled trial. Trials 2014; 15:330. [PMID: 25141962 PMCID: PMC4148541 DOI: 10.1186/1745-6215-15-330] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 08/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast neoplasms are the second most common type of cancer worldwide, and radiation therapy is a key component of their treatment. Acute skin reactions are one of the most common side effects of radiation therapy, and prevention of this adverse event has been investigated in several studies. However, a clinically applicable, preventative treatment remains unavailable. It has been demonstrated that application of a low-power laser can promote tissue repair. Therefore, the aim of this trial is to evaluate the effectiveness of an indium gallium aluminum phosphorus (InGaAIP) laser operated at 660 nm in preventing radiodermatitis in women undergoing adjuvant radiotherapy for breast cancer. METHODS/DESIGN This is a two-arm, randomized controlled trial. A total of 52 patients undergoing radiotherapy for breast cancer (stages I to III) will be enrolled. Patients will be randomly assigned to an intervention group to receive laser therapy (n = 26) or a control group to receive a placebo (n = 26). The laser or placebo will be applied five days a week, immediately before each radiotherapy session. Skin reactions will then be graded weekly by a nurse, a radiotherapist, and an oncologist (all of whom will be blinded) using the Common Toxicity Criteria (CTC) developed by the National Cancer Institute and the Acute Radiation Morbidity Scoring Criteria developed by the Radiation Therapy Oncology Group. Patients will also answer a modified visual analogue scale for pain (a self-evaluation questionnaire). Primary and secondary outcomes will be the prevention of radiodermatitis and pain secondary to radiodermatitis, respectively. DISCUSSION The ideal tool for preventing radiodermatitis is an agent that mediates DNA repair or promotes cell proliferation. Application of a low-power laser has been shown to promote tissue repair by reducing inflammation and inducing collagen synthesis. Moreover, this treatment approach has not been associated with adverse events and is cost-effective. Thus, the results of this ongoing trial may establish whether use of a low-power laser represents an ideal treatment option for the prevention of radiodermatitis. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02003599. Registered on 2 December 2013.
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Affiliation(s)
| | | | | | | | | | | | - Daniela Francescato Veiga
- Department of Plastic Surgery, Universidade do Vale do Sapucaí, Avenida Prefeito Tuany Toledo, Pouso Alegre - MG CEP 37550-000, Brazil.
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Shao Y, Qi K, Zhou QH, Zhong DS. Intermittent pneumatic compression pump for breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials. Oncol Res Treat 2014; 37:170-4. [PMID: 24732640 DOI: 10.1159/000360786] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/20/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Breast cancer-related lymphedema (BCRL) is a common complication after the treatment of breast cancer. The objective of this study was to determine whether the use of an intermittent pneumatic pump (IPC) could manage lymphedema effectively. METHODS We searched PubMed, EMBASE, and the Cochrane Library for related trials to compare the percent of volume reduction and subjective symptoms. RESULTS 7 randomized controlled trials, with 287 patients, were included. Results showed that the use of the IPC could alleviate lymphedema, but no significant difference between routine management of lymphedema with or without pneumatic pump existed. CONCLUSION Current trials fail to show the effectiveness of the addition of an IPC to the routine management of BCRL.
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Affiliation(s)
- Yi Shao
- Tianjin Medical University General Hospital, Tianjin, China
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Rodrick JR, Poage E, Wanchai A, Stewart BR, Cormier JN, Armer JM. Complementary, alternative, and other noncomplete decongestive therapy treatment methods in the management of lymphedema: a systematic search and review. PM R 2013; 6:250-74; quiz 274. [PMID: 24056160 DOI: 10.1016/j.pmrj.2013.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/08/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES (1) To provide a critical analysis of the contemporary published research that pertains to complementary, alternative, and other noncomplete decongestive therapies for treatment of lymphedema (LE), and (2) to provide practical applications of that evidence to improve care of patients with or at risk for LE. TYPE: This study meets the defining criteria as a systematic search and review because it includes varied study types. All studies that met the inclusion criteria were evaluated for weight of evidence and value. LITERATURE SURVEY The systematic search and review includes articles published in the contemporary literature (2004-2012). Publications published from 2004-2011 were retrieved from 11 major medical indices by using search terms for LE and management approaches. Literature archives were examined through 2012. Data extraction included study design, objectives pertaining to LE, number and characteristics of participants, interventions, and outcomes. Study strengths and weaknesses were summarized. Study evidence was categorized according to the Oncology Nursing Society Putting Evidence into Practice level-of-evidence guidelines after achieving consensus among the authors. No authors participated in development of nor benefitted from the review of these modality methods or devices. METHODOLOGY Extracted data from 85 studies were reviewed in 4 subcategories: botanical, pharmaceutical, physical agent modality, and modalities of contemporary value. After review, 47 articles were excluded, which left 16 articles on botanicals and pharmaceuticals and 22 articles for physical agent modality and/or modalities of contemporary value. Pharmaceuticals were later excluded. The authors concluded that botanicals had generated sufficient studies to support a second, more specific systematic review; thus, botanicals are reported elsewhere. SYNTHESIS It was found that limited high-level evidence was available for all categories. Well-constructed randomized controlled trials related specifically to LE were limited. Objective outcome measures over time were absent from several studies. The rationale for the use and benefits of the specific modality, as related to LE, was often anecdotal. Subject numbers were fewer than 50 for most studies. CONCLUSIONS No interventions were ranked as "recommended for practice" based on the Putting Evidence into Practice guidelines. Two treatment modalities in 3 studies were ranked as "likely to be effective" in reducing LE or in managing secondary LE complications. Consideration should be given that many of the PAMs demonstrate long-standing support within the literature, with broad parameters for therapeutic application and benefit for secondary conditions associated with LE. However, further investigation as to their individual contributory value and the factors that contribute to their efficacy, specific to LE, has not been done. It also is significant to mention that the majority of these studies focused on breast cancer-related LE. Studies that explored treatment interventions for LE-related vascular disorders (eg, chronic venous insufficiency, congenital dysphasia, trauma) were sparse. Limitations of the literature support the recommendations for future research to further examine the level of evidence in these modalities for LE management.
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Affiliation(s)
- Julia R Rodrick
- St. John's Hospital, Rehab South Outpatient Therapies, Springfield, IL(∗)
| | - Ellen Poage
- Rehabilitation Associates of Naples, Naples, FL(†)
| | - Ausanee Wanchai
- University of Missouri Sinclair School of Nursing, Columbia, MO; Boromarajonani College of Nursing, Buddhachinaraj, Thailand(‡)
| | - Bob R Stewart
- University of Missouri Sinclair School of Nursing, Columbia, MO(§)
| | - Janice N Cormier
- Departments of Surgical Oncology and Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX(‖)
| | - Jane M Armer
- University of Missouri Sinclair School of Nursing, Mizzou North 408 DC 116.05, Columbia, MO, 65212(¶).
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Fialka-Moser V, Korpan M, Varela E, Ward A, Gutenbrunner C, Casillas J, Delarque A, Berteanu M, Christodoulou N. The role of physical and rehabilitation medicine specialist in lymphoedema. Ann Phys Rehabil Med 2013; 56:396-410. [DOI: 10.1016/j.rehab.2013.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 02/27/2013] [Indexed: 11/30/2022]
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Palmieri B, Di Cerbo A, Rottigni V, Fistetto G, Iannitti T. The feasibility of a fiber optic laser approach to relieving lymphedematous syndrome: a case report. Onco Targets Ther 2013; 6:85-8. [PMID: 23425774 PMCID: PMC3576130 DOI: 10.2147/ott.s39420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Here we report a case of successful fiber optic laser treatment of lymphedema in a swollen arm post mastectomy. At the moment, this procedure has only anecdotal evidence to justify its use, but in our experience is a feasible, minimally invasive day-stay procedure which has been demonstrated to be safe and effective. Further nonhomogeneous case pooling and follow-up would enable guidelines and definite surgical protocols for its use to be implemented.
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Affiliation(s)
- Beniamino Palmieri
- University of Modena, Department of General Surgery and Surgical Specialties, Modena, Italy ; Poliambulatorio del Secondo Parere, Modena, Italy
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Hara H, Mihara M, Okuda I, Hirota A, Narushima M, Iida T, Yamamoto T, Todokoro T, Koshima I. Presence of thoracic duct abnormalities in patients with primary lymphoedema of the extremities. J Plast Reconstr Aesthet Surg 2012; 65:e305-10. [DOI: 10.1016/j.bjps.2012.04.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/30/2012] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
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Omar MTA, Shaheen AAM, 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; 20:2977-84. [PMID: 22875413 DOI: 10.1007/s00520-012-1546-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 07/23/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to review the effect of low-level laser therapy (LLLT) in the management of breast cancer-related lymphedema (BCRL). METHODS A systematic review of seven databases for clinical trials for LLLT in the management of BCRL published between 1990 and 2011 was performed. RESULTS A total of eight studies on 230 patients were found. The methodological qualities of the selected studies were assessed with the Physiotherapy Evidence Database scale, and the studies were categorized according to Sackett's levels of evidence. Five studies were graded at evidence level II. Two studies were graded at evidence level III, and the remaining study was graded at evidence level V. CONCLUSIONS There is moderate to strong evidence for the effectiveness of LLLT for the management of BCRL from five small studies of acceptable methodological quality. A dose of 1-2 J/cm(2) per point applied to several points covering the fibrotic area can reduce limb volume following BCRL. Further well-designed, large-scale studies are required to determine more precisely how effective LLLT may be in BCRL.
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Affiliation(s)
- Mohammed Taher Ahmed Omar
- Physical Therapy Department for Surgery, Faculty of Physical Therapy, Cairo University, 7 Ahmed Elziat Street, Giza, Egypt.
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Hayes SC, Johansson K, Stout NL, Prosnitz R, Armer JM, Gabram S, Schmitz KH. Upper-body morbidity after breast cancer. Cancer 2012; 118:2237-49. [DOI: 10.1002/cncr.27467] [Citation(s) in RCA: 233] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Blei F. Literature Watch. Lymphat Res Biol 2011. [DOI: 10.1089/lrb.2011.9302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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