ABSTRACT
Objective:To systematic review the efficacy and safety of external application of traditional Chinese medicine on treatment of breast cancer related lymphedema.Methods:CNKI, Wanfang Data, VIP, Sino-Med, The Cochrane Library, PubMed, Web of Science were searched for related randomized controlled trials, the retrieval time was from inception to May 25, 2020. Two researchers independently screened and evaluated the included studies. Meta-analysis was performed by RevMan 5.4 software.Results:A total of 16 studies involving 1 315 patients with breast cancer related lymphedema were included, and the methodological quality of the included studies was not high. Compared with conventional treatment, external application of traditional Chinese medicine combined with conventional treatment had advantages in improving the total efficiency( P<0.01) and quality of life( P<0.01), reducing pain( P<0.01) and improving upper limb function( P<0.01), without obvious adverse reactions( P>0.05), but there was no improvement in depression( P>0.05). Compared with conventional treatment, external application of traditional Chinese medicine could improve the total efficiency( P<0.01). Compared with placebo sticker combined with conventional treatment, external application of traditional Chinese medicine combined with conventional treatment can reduce circumference( P<0.05) and reduce pain( P<0.01), without obvious adverse reactions( P>0.05). Conclusions:Available evidence suggests that external application of traditional Chinese medicine may be a potential treatment method for breast cancer related lymphedema. Due to the poor methodological quality of the included studies, high-quality randomized controlled trials are still needed.
ABSTRACT
Objective: To investigate the correlation between body mass index (BMI) and the incidence of breast cancer (BC) related lymphedema (BCRL) in Chinese patients over the period following postoperative radiotherapy (RT). Methods: This study included 281 female patients with single-sided BC who were treated at The Fourth Hospital of Hebei Medical University between November 2013 and February 2015. The clinical data of these patients were collected prospectively and analyzed. Based on their BMI, the patients were classified into three subgroups: low BMI (BMI BMI>25, n=89), and high BMI (BMI≥28, n=98). The upper limb volume difference (ULVD) was compared between the diseased and healthy one. Univariate and multivariate generalized estimating equations (GEE) and linear logistic regression models were used to estimate the effects of RT and BMI on BCRL (defined as a ULVD ≥200 mL). In addition, these results were compared among the three BMI subgroups. Results: The mean ULVD before and after RT were 40.6 and 42.9 mL, respectively. The median ULVD before and after therapy remained constant at 30.0 mL; no significant difference was observed (P>0.05). Two and single patient respectively lacked one arm volume measurement before and after RT. The BCRL incidence rates in the low, middle, and high BMI subgroups before RT were 2.2% (2/93), 6.8% (6/88), and 13.3% (13/98); the corresponding rates after RT were 1% (1/93), 12.4% (11/89), and 12.2% (12/98), respectively. The GEE model indicated that RT did not cause an increase in the incidence rate of BCRL (P=0.529). Multivariable logistic regression for the middle and high BMI subgroups before RT (RR=4.199, P=0.693 and RR=10.999, P=0.002, respectively) and after RT (RR=13.287, P=0.047 and RR=14.308, P=0.029, respectively) indicated a significantly higher risk of BCRL in the high BMI subgroup . Similar results were obtained from the subgroup analyses of the middle BMI subgroup. Conclusions: The incidence and severity of BCRL do not decrease during the period following postoperative RT. Among Chinese BC patients, a lower threshold BMI of 28 kg/m2 appears to be associated with BCRL after RT. This is distinctly different from the commonly reported BMI threshold of 30 kg/m2 in most European and American studies.
ABSTRACT
Este estudo objetivou analisar, por meio de uma revisão sistemática da literatura, a influência da reconstrução imediata na prevalência de linfedema após mastectomia em pacientes portadoras de câncer de mama. Foram analisados os mais relevantes estudos publicados originalmente em qualquer idioma até agosto de 2018, indexados às bases de dados US National Library of Medicine, Cochrane Central Register of Controlled Trials, Web of Science e Scientific Electronic Library Online. A amostra foi composta por 10 publicações que se adequaram aos critérios de inclusão e exclusão estabelecidos, incluindo 2.425 pacientes submetidas a apenas mastectomia e 2.772 pacientes submetidas à mastectomia associada à reconstrução imediata da mama. A prevalência de linfedema foi 20,95% nas pacientes submetidas a apenas mastectomia (n = 508) e de 5,23% nas pacientes submetidas à mastectomia associada à reconstrução imediata (n = 145), havendo diferença estatisticamente significativa (p < 0,001). Concluiu-se que a mastectomia associada à reconstrução imediata influencia positivamente o prognóstico das pacientes portadoras de câncer de mama, proporcionando um índice significativamente menor de linfedema, quando comparada à realização de apenas mastectomia.
This study aimed to analyze, through systematic review of literature, the influence of immediate reconstruction on the prevalence of lymphedema after mastectomy, in women living with breast cancer. The analysis considered the most relevant studies originally published, in any language, up to August 2018, indexed on the databases of the US National Library of Medicine, Cochrane Central Register of Controlled Trials, Web of Science, and Scientific Electronic Library Online. The sample comprised 10 publications that met the established criteria for inclusion and exclusion, including 2,425 patients who were subjected to mastectomy alone, and 2,772 patients who were subjected to mastectomy associated with immediate reconstruction of the breast. The prevalence of lymphedema was 20.95% in patients who had been subjected to mastectomy alone (n = 508), and 5.23% among those patients who were subjected to mastectomy associated with immediate reconstruction of the breast (n = 145), the difference being statistically significant (p < 0.001). We concluded that mastectomy, when associated with immediate breast reconstruction, has a positive influence on the prognosis of patients living with breast cancer, thereby providing a much lower rate of lymphedema when compared with mastectomy alone.
Subject(s)
Humans , Adult , Middle Aged , Aged , Breast Neoplasms/surgery , Mammaplasty/adverse effects , Mammaplasty/methods , Mammaplasty/rehabilitation , Breast Cancer Lymphedema/surgery , Breast Cancer Lymphedema/pathology , Lymphedema/complicationsABSTRACT
Objective:To compare arm circumference (AC) and upper limb volume (ULV) in assessment of breast cancer related lymphedema (BCRL). Methods:From November, 2013 to February, 2015, 281 women with one-sided breast cancer accepting radiotherapy were consecutively enrolled. AC was measured as the means of circumference 10 cm above and 5 cm below the most eminent midpoint of olecranon. ULV was measured as the water displacement volume when the water surface reached at 15 cm above the midpoint of olecranon. Univariate and multivariable linear regressions were used between AC and ULV. Results:All the correlated coefficients between AC and In(ULV) were above 0.959 (P < 0.001). For linear equations, the R2 > 0.90. The consistency of diagnoses of BCRL with AC and ULV were above 90% (Kappa > 0.492, P < 0.001). Conclusions:AC and ULV are consistent in measurement of BCRL. AC is reliable and easier.
ABSTRACT
OBJECTIVE: To find out whether levels of fibrin degradation products (FDP) and D-dimer are increased in breast cancer-related lymphedema (BCRL) as in many vascular diseases. FDP and D-dimer have been used in blood tests to help differentiate deep vein thrombosis in the diagnosis of lymphedema. Levels of FDP and D-dimer are often elevated in patients with BCRL. METHODS: Patients with BCRL (group I), non-lymphedema after breast cancer treatment (group II), and deep venous thrombosis (group III) from January 2012 to December 2016 were enrolled. Levels of FDP and D-dimer were measured in all groups and compared among groups. RESULTS: Mean values of FDP and D-dimer of group I were 5.614±12.387 and 1.179±2.408 μg/μL, respectively. These were significantly higher than their upper normal limits set in our institution. Levels of FDP or D-dimer were not significantly different between group I and group II. However, values of FDP and D-dimer in group III were significantly higher than those in group I. CONCLUSION: Values of FDP and D-dimer were much higher in patients with thrombotic disease than those in patients with lymphedema. Thus, FDP and D-dimer can be used to differentiate between DVT and lymphedema. However, elevated levels of FDP or D-dimer cannot indicate the occurrence of lymphedema.
Subject(s)
Humans , Breast Neoplasms , Breast , Diagnosis , Fibrin Fibrinogen Degradation Products , Fibrin , Hematologic Tests , Lymphedema , Vascular Diseases , Venous ThrombosisABSTRACT
[Summary] With the development of diagnosis and treatment levels and the improvement of survival rates of breast cancer , related lymphedema has received increasing attention .In a long term, it is regarded as the primary complication after the breast cancer therapy , which affects the quality of life of patients .Due to lack of consensus in many aspects worldwide , it continues to be a challenge to diagnose and treat the disease .This article aimed to summarize the diagnosis and therapeutics of breast cancer related lymphedema .
ABSTRACT
OBJECTIVE: To investigate the usefulness of bioimpedance measurement for predicting the treatment outcome in breast cancer related lymphedema (BCRL) patients. METHOD: Unilateral BCRL patients who received complex decongestive therapy (CDT) for 2 weeks (5 days per week) were enrolled in this study. We measured the ratio of extracellular fluid (ECF) volume by using bioelectrical impedance spectroscopy (BIS), and single frequency bioimpedance analysis (SFBIA) at a 5 kHz frequency before treatment. Arm circumferences were measured at 10 cm above and below the elbow before and after treatment. We also investigated whether there is correlation between ECF ratio and SFBIA ratio with the change of arm circumference after CDT. RESULTS: A total of 73 patients were enrolled in this study. The higher ECF ratio was significantly correlated with higher reduction of arm circumference at both above and below the elbow after treatment, but the higher SFBIA ratio was correlated only with the higher reduction of arm circumference below the elbow. CONCLUSION: These results show that ECF volume measurements and SFBIA before treatment are useful tools for predicting the outcome of patients with lymphedema. We concluded that ECF volume measure can be used as a screening tool for predicting treatment outcome of BCRL patients.