Treatment of lymphedema in the presence locoregional tumors

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Treatment of lymphedema in the presence locoregional tumors

Postby patoco » Thu Dec 20, 2007 7:57 pm

Manipulative therapy of secondary lymphedema in the presence of
locoregional tumors.


Cancer. 2007 Dec 17

Pinell XA, Kirkpatrick SH, Hawkins K, Mondry TE, Johnstone PA.
Radiation Oncology Department, Emory University School of Medicine,
Atlanta, Georgia.

BACKGROUND: Complete decongestive therapy (CDT), including manual lymphatic drainage (MLD) is a manipulative intervention of documented benefit to patients with lymphedema (LE). Although the role of CDT for LE is well described, to the authors' knowledge there are no data regarding its efficacy for patients with LE due to tumor masses in the
draining anatomic bed. Traditionally, LE therapists are wary of
providing therapy to such patients with 'malignant' LE for fear of
exacerbating the underlying cancer, and that the obstruction will
render therapy less effective. In the current study, the authors'
experience providing CDT for such patients is discussed.

METHODS: Cancer survivors with LE were referred to therapists at 2 Atlanta-area clinics. CDT consists of treatment (Phase 1) and
maintenance phases (Phase 2). During Phase 1, the patient undergoes
manipulative therapy and bandaging daily until the LE reduction
plateaus; at that point, Phase 2 (self-care) begins. At the beginning
and end of Phase 1, LE is quantified and differences in girth volume
calculated. The results for patients completing Phase 1 therapy for LE
in the presence of locoregional masses were compared with results for
patients with LE in the absence of such disease. Both volume reduction
of the affected limb and number of treatments to plateau were
analyzed.

RESULTS: Between January 2004, and March 2007, LE of 82 limbs in 72 patients was treated with CDT and Phase 1 was completed. The median number of treatments to plateau was 12 (range, 4-23 treatments); the median limb volume reduction was 22% (range, -23 to 164%). Nineteen limbs (16 patients) with associated chest wall/axillary or pelvic/ inguinal tumors had nonsignificant difference in LE reduction (P = .
75) in the presence of significantly more sessions to attain plateau
(P = .0016) compared with 63 limbs in 56 patients without such
masses.

CONCLUSIONS: Patients with LE may obtain relief with CDT regardless of whether they have locoregional disease contributing to their
symptoms. However, it will likely take longer to achieve that effect.
Manipulative therapy of LE should not be withheld because of
persistent or recurrent disease in the draining anatomic bed. Cancer
2008. (c) 2007 American Cancer Society.

PMID: 18085587 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum

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