Szuba A, Achalu R, Rockson SG.
Decongestive lymphatic therapy for patients with breast carcinoma-associated
lymphedema. A randomized, prospective study of a role for adjunctive pneumatic
compression.
Cancer 2002 Dec 1;95(11):2260-7     weiter zur Übersetzten Vollversion

Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular
Medicine, Stanford University School of Medicine, Stanford, California 94305, USA.

BACKGROUND: Disruption of the lymphatic circulation through breast
carcinoma-associated axillary lymph node dissection, with or without radiation
therapy, reportedly is the most common cause of lymphedema in developed
countries. There is no cure for breast carcinoma-associated lymphedema. Although
intermittent pneumatic compression (IPC) has been acknowledged as a potential
component of the multidisciplinary therapeutic strategy in the treatment of
patients with breast carcinoma-associated lymphedema, prospective study of its
adjunctive safety and efficacy is required. METHODS: IPC was assessed as a
component of the initial therapeutic regimen for newly treated patients with
breast carcinoma-associated lymphedema. Twenty-three patients who had not
previously been treated for lymphedema were randomized to receive either
decongestive lymphatic therapy (DLT) alone or DLT with daily adjunctive IPC.
Patients with stable, treated, breast carcinoma-associated lymphedema also were
assessed in the maintenance phase of therapy. Twenty-seven patients were
randomized either to DLT alone or to DLT coupled with daily IPC. In both studies,
objective assessment included serial measurement of volume by water displacement,
tissue tonometry to assess elasticity of the skin, and goniometry to measure
joint mobility. RESULTS: During initial treatment, the addition of IPC to
standard DLT yielded an additional mean volume reduction (45.3% vs. 26%; P <
0.05). During maintenance DLT alone, there was a mean increase in volume (32.7
+/- 115.2 mL); with DLT and IPC, there was a mean volume reduction (89.5 +/-
195.5 mL; P < 0.05). In both studies, IPC was tolerated well without detectable
adverse effects on skin elasticity or joint range of motion. CONCLUSIONS: When
IPC is used adjunctively with other, established elements of DLT, it provides an
enhancement of the therapeutic response. IPC is well tolerated and remarkably
free of complications. Copyright 2002 American Cancer Society.DOI
10.1002/cncr.10976