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Fourgeaud C, Vignes S. New insights in breast cancer-related lymphedema. JOURNAL DE MEDECINE VASCULAIRE 2024; 49:135-140. [PMID: 39278693 DOI: 10.1016/j.jdmv.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 06/13/2024] [Indexed: 09/18/2024]
Abstract
Upper limb lymphedema after breast cancer treatment including axillary dissection occurs in almost 20% of women. Its treatment consists of complete decongestive physiotherapy based on low-stretch bandage to reduce volume, followed by elastic compression to maintain it. In this article, we will detail recent data on lymphedema risk factors with possible genetic predisposition, prevention (surgical, compression), manual lymphatic drainage, physical activity, weight, advice, and treatments including gene therapy.
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Affiliation(s)
- Caroline Fourgeaud
- Department of Lymphology, Cognacq-Jay Hospital, centre de référence des lymphœdèmes primaires, 15, rue Eugène Millon, 75015 Paris, France
| | - Stéphane Vignes
- Department of Lymphology, Cognacq-Jay Hospital, centre de référence des lymphœdèmes primaires, 15, rue Eugène Millon, 75015 Paris, France.
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Vignes S, Devoogdt N, Thomis S, Damstra R. Correspondence to the article: "Effectiveness of manual lymphatic drainage in intensive phase I therapy of breast cancer-related lymphedema - a retrospective analysis" by Renato G. Kasseroller and Erich Brenner, and published online on December 5, 2023, doi: 10.1007/s00520-023-08210-7. Support Care Cancer 2024; 32:132. [PMID: 38277074 DOI: 10.1007/s00520-024-08335-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Stéphane Vignes
- Department of Lymphology and Reference Center for Primary Lymphedema, Cognacq-Jay Hospital, 15, Rue Eugène-Millon, 75015, Paris, France.
| | - Nele Devoogdt
- Department of Vascular Surgery and Center for Lymphedema, University Hospitals Leuven, and Department of Rehabilitation Sciences, KU Louvain - University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Sarah Thomis
- Department of Vascular Surgery and Center for Lymphedema, University Hospitals Leuven, and Department of Cardiovascular Sciences, KU Louvain - University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Robert Damstra
- Expert Center for Lymphovascular Medicine, Nij Smellinghe Hospital, Compagnonsplein 1, 9202 NN, Drachten, the Netherlands
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Da Cuña-Carrera I, Soto-González M, Abalo-Núñez R, Lantarón-Caeiro EM. Is the Absence of Manual Lymphatic Drainage-Based Treatment in Lymphedema after Breast Cancer Harmful? A Randomized Crossover Study. J Clin Med 2024; 13:402. [PMID: 38256536 PMCID: PMC10816533 DOI: 10.3390/jcm13020402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Manual lymphatic drainage (MLD), included within the complex decongestive therapy, as a therapy for the treatment of lymphedema has raised controversy about its benefits for lymphedema after breast cancer. The aim of this research is to test the effects of MLD on lymphedema after breast cancer during the treatment maintenance phase. (2) Methods: A randomized, single-blinded, controlled crossover trial was conducted to analyze the effects of a manual lymphatic drainage intervention compared to a control group without MLD intervention for the treatment of lymphedema. Arm volume measured by circumference measurement, subcutaneous tissue thickness measured by ultrasound, and the sensation of pain, heaviness, and swelling were evaluated as outcome measures. (3) Results: For the control group, an increase in volume was found in some of the circumference and subcutaneous tissue thickness measurements, in addition to a worsening of arm pain, swelling and heaviness. (4) Conclusion: The absence of treatment based on MLD in lymphedema after breast cancer worsens volume measurements, as well as arm heaviness. Therefore, it would be advisable to carry out this type of therapy as part of the maintenance treatment for lymphedema in breast cancer.
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Affiliation(s)
- Iria Da Cuña-Carrera
- Clinic Physiotherapy Group, Galicia South Health Research Institute, Servicio Galego de Saúde, 36312 Vigo, Spain; (I.D.C.-C.); (R.A.-N.); (E.M.L.-C.)
- Faculty of Physiotherapy, Campus A Xunqueira s/n, University of Vigo, 36005 Pontevedra, Spain
| | - Mercedes Soto-González
- Clinic Physiotherapy Group, Galicia South Health Research Institute, Servicio Galego de Saúde, 36312 Vigo, Spain; (I.D.C.-C.); (R.A.-N.); (E.M.L.-C.)
- Faculty of Physiotherapy, Campus A Xunqueira s/n, University of Vigo, 36005 Pontevedra, Spain
| | - Rocío Abalo-Núñez
- Clinic Physiotherapy Group, Galicia South Health Research Institute, Servicio Galego de Saúde, 36312 Vigo, Spain; (I.D.C.-C.); (R.A.-N.); (E.M.L.-C.)
- Faculty of Physiotherapy, Campus A Xunqueira s/n, University of Vigo, 36005 Pontevedra, Spain
| | - Eva M. Lantarón-Caeiro
- Clinic Physiotherapy Group, Galicia South Health Research Institute, Servicio Galego de Saúde, 36312 Vigo, Spain; (I.D.C.-C.); (R.A.-N.); (E.M.L.-C.)
- Faculty of Physiotherapy, Campus A Xunqueira s/n, University of Vigo, 36005 Pontevedra, Spain
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Lu H, Shao Q, Li W, Li F, Xiong W, Li K, Feng W. Effects of manual lymphatic drainage on total knee replacement: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2024; 25:30. [PMID: 38167036 PMCID: PMC10763325 DOI: 10.1186/s12891-023-07153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Total knee joint replacement (TKR) is an effective method for the treatment of severe knee osteoarthritis. With an increasing number of surgeries, complications such as lower limb edema, pain, and limited mobility have caused a heavy burden. Manual lymphatic drainage (MLD) may be a solution to solve the problem. The study aims to evaluate the efficacy of MLD in reducing knee edema, pain, and improving range of motion (ROM) in patients after TKR. METHODS A search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIPs, WanFang database, and Google Scholar from inception to June 2023. Only randomized controlled trials (RCTs) that compared the effects of MLD and non-MLD (or another physiotherapy) on improving knee edema, pain, and ROM after TKR were included. Stata 16.0 was used for meta-analysis. GRADE was used to assess the quality of evidence. RESULTS In total, 7 RCTs with 285 patients were identified. There were no significant differences found in the ROM of knee flexion (standardized mean difference (SMD) = 0.03, 95% confidence interval (CI): -0.22, 0.28, P = 0.812) and the ROM of knee extension (SMD= -0.30, 95%CI: -0.64, 0.04, P = 0.084). No differences were observed in the lower extremity circumference after TKR (SMD= -0.09, 95%CI: -0.27, 0.09, P = 0.324). For postoperative pain, there was no significant advantage between the MLD and non-MLD groups (SMD= -0.33, 95%CI: -0.71, 0.04, P = 0.083). CONCLUSIONS Based on the current evidence from RCTs, manual lymphatic drainage is not recommended for the rehabilitation of patients following total knee replacement.
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Affiliation(s)
- Hongyuan Lu
- Guanghua Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, 200052, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Quanwei Shao
- Yangpu District Central Hospital, Shanghai, 200090, China
| | - Wenyao Li
- Shanghai No.4 Rehabilitation Hospital, Shanghai, 200040, China
| | - Fei Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- Shanghai Fourth People's Hospital, Shanghai, 200040, China
| | - Weiyi Xiong
- Shanghai Fourth People's Hospital, Shanghai, 200040, China
| | - Kunpeng Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Wei Feng
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- The Second Rehabilitation Hospital of Shanghai, Shanghai, 202441, China.
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Devoogdt N, Thomis S, De Groef A, Heroes AK, Nevelsteen I, Gebruers N, Tjalma WAA, Belgrado JP, Monten C, Hanssens M, De Vrieze T. The Effectiveness of Fluoroscopy-Guided Manual Lymph Drainage as Part of Decongestive Lymphatic Therapy on the Superficial Lymphatic Architecture in Patients with Breast Cancer-Related Lymphoedema: A Randomised Controlled Trial. Cancers (Basel) 2023; 15:cancers15051545. [PMID: 36900336 PMCID: PMC10000864 DOI: 10.3390/cancers15051545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
The objective of this trial was to investigate the effectiveness of fluoroscopy-guided manual lymph drainage (MLD), as part of decongestive lymphatic therapy (DLT), on the superficial lymphatic architecture in patients with chronic mild to moderate breast cancer-related lymphoedema (BCRL). This trial was a multicentre, double-blind, randomised controlled trial involving 194 participants with BCRL. Participants were randomised into (1) DLT with fluoroscopy-guided MLD (intervention group), (2) DLT with traditional MLD (control group), or (3) DLT with placebo MLD (placebo group). Superficial lymphatic architecture was evaluated as a secondary outcome, visualised by ICG lymphofluoroscopy at the baseline (B0), post-intensive (P), and post-maintenance phases (P6). Variables were (1) number of efferent superficial lymphatic vessels leaving the dermal backflow region, (2) total dermal backflow score, and (3) number of superficial lymph nodes. The traditional MLD group showed a significant decrease in the number of efferent superficial lymphatic vessels at P (p = 0.026), and of the total dermal backflow score at P6 (p = 0.042). The fluoroscopy-guided MLD and placebo group showed significant decreases in the total dermal backflow score at P (p < 0.001 and p = 0.044, respectively) and at P6 (p < 0.001 and p = 0.007, respectively); the placebo MLD group showed a significant decrease in the total number of lymph nodes at P (p = 0.008). However, there were no significant between-group differences for the changes in these variables. In conclusion, based on lymphatic architecture outcomes, the added value of MLD, in addition to the other parts of DLT, could not be demonstrated in patients with chronic mild to moderate BCRL.
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Affiliation(s)
- Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
- Correspondence:
| | - Sarah Thomis
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, 2610 Antwerp, Belgium
| | - An-Kathleen Heroes
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
- Department of Vascular Surgery, Centre for Lymphedema, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
| | - Ines Nevelsteen
- Multidisciplinary Breast Centre, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
| | - Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, 2610 Antwerp, Belgium
- Multidisciplinary Breast Clinic and Multidisciplinary Oedema Clinic, Antwerp University Hospital, 2650 Antwerp, Belgium
| | - Wiebren A. A. Tjalma
- Multidisciplinary Breast Clinic and Multidisciplinary Oedema Clinic, Antwerp University Hospital, 2650 Antwerp, Belgium
- Department of Medicine, University of Antwerp, MIPRO, 2610 Antwerp, Belgium
| | - Jean-Paul Belgrado
- Lymphology Research Unit, Université libre de Bruxelles, 1070 Brussels, Belgium
| | - Chris Monten
- Department of Radiotherapy, Ghent University Hospital, 9000 Ghent, Belgium
| | - Marianne Hanssens
- Department of Oncology, Centre for Oncology, General Hospital Groeninge, 8500 Kortrijk, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, 2610 Antwerp, Belgium
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What do we know about treating breast-cancer-related lymphedema? Review of the current knowledge about therapeutic options. Breast Cancer 2023; 30:187-199. [PMID: 36571707 PMCID: PMC9950281 DOI: 10.1007/s12282-022-01428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022]
Abstract
Breast-cancer-related lymphedema (BCRL) is a common consequence of oncological treatment. Its management is a complicated, chronic, and arduous process. Therapeutic options can be divided on non-surgical and surgical methods, although there is still no clear consensus about their effectiveness in preventing or stopping the disease. That brings problems in everyday practice, as there are no guidelines about proper time for starting therapy and no agreement about which management will be beneficial for each patient. The aim of this review is to summarize current knowledge about possible treatment choices, non-surgical so as surgical, indicate knowledge gaps, and try to direct pathways for future studies.
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