Pecking A.P., Cluzan R.V.
Results of a self sequential pressotherapy as a substitute for classical
decongestive therapy in a group of patients with a refractory upper limb lymphedema
XIX.International Congress of Lymphology 01-06.Sept.2003 Freiburg/Germany

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Introduction : Upper limb lymphedema occurs in about 19% of patients treated for breast cancer.
Usually a standard decongestive therapy associating manual lymphatic drainage
and bandages gives significant results. However, this therapeutic strategy requires
a well trained physiotherapist to warrant satisfying results. In some situations,
patients have no access to a well trained physiotherapist and the treatment
applied is not working. The lack of efficacy of the treatment leads to an
anxiogenic situation for the patient and in some cases a treatment withdrawal.
We develop with the sponsoring of the French league against cancer
(Comité départemental des Hauts de Seine de la ligue nationale contre le cancer)
a special protocol dedicated to offer the patient a new therapeutic
approach to their lymphedemas.

Method and patients : 50 women, age ranging from 38 to 79 years were included
in this trial. All were presenting an upper limb lymphedema after a breast cancer
treatment without any signs of a local recurrence or distant metastasis.
These women were previously treated with a standard decongestive therapy
without any success. Main reasons for treatment failure were

physiotherapist not well trained, distance from home to physiotherapy office,
insufficient time to do the treatment. A test for pressotherapy was first performed
in our institute. Patients with. a significant response were educated to use a small
pneumatic pump with multiple chambers. This self-sequential pressotherapy
(pression 50 mm Hg) was then performed daily for 1 hour (2 sequences of 30 minutes)
during 2 months. 35 patients underwent a second course 3 months later.
Results 5 patients had no benefit of the self pressotherapy,
3 of them developed local recurrence. The tw others were not
really compliant and had a discontinuous use of the device.
Forty-five (90%) had a mild to important significant response.
The average percentage of volume reduction is 43% (19-67), the decrease
in heaviness of the affected limb was constant, pain was noticed for
16 patients and disappeared in 9 of them (56%). There was a clear
functional improvement in 8 out of 11 patients with limited
mobility of the arm. Lymphoscintigraphic parameters were improved
in 35% particularly on the lymphatic speed. Quality of life was improved
for 39 patients (78%) and all patients declared themselves satisfied this
treatment is easy to be performed at home. A second course was applied
to 35 patients 3 months later with a similar rate of success.

Conclusion : This non conventional approach was developed in order to offer
a potential therapeutic alternative to patients unable to have a good
decongestive therapy. The results obtained are really significant,
with a high level in satisfaction. With an average time saved for a
week estimated at 10 hours and a success rate of 90% this method
justified itself and should therefore perhaps be used more frequently.
However the high cost of the device is a financial limitation.