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Objective To explore the effects of complex decongestive therapy among patients with postoperative lower extremity lymphedema following treatment for gynecological cancer. Methods A total of 40 patients with secondary lower extremity lymphedema resulting from gynecological cancer treatment received complex decongestive physiotherapy (CDP) by oncology nursing specialist in the lymphedema rehabilitation clinic between March 2016 to February 2017.Before and after CDP,patients were evaluated by circumferential measurements and multiple frequency bioelectrical impedance analysis. Results After CDP, lymphedema volume decreased from (8 668.30 ± 1 909.23) cm3to (7 599.81 ± 1 297.45)cm3, and the percentage of excess volume (PEV) reduced from 14.10 (5.82-66.86)% to 2.95(0.38-28.56)%, the differences were statistically significant(t=6.909,Z=-5.511,P<0.05).The accumulated edema fluid in tissue decreased from(6.11±1.63)L to (5.06 ± 0.88) L and the rate of extracellular water decreased from (41.15 ± 1.86)% to (39.51 ± 0.88)%, the differences were statistically significant (t=6.336, 8.295, P < 0.05). Percentage reduction of excess volume (PREV)was(77.33±14.55)%,and was correlated with duration of lower extremity lymphedema. Conclusions CDP was effective for lower extremity lymphedema secondary to treatment of gynecological cancer.It is a set of safe and noninvasive technique. Patients with lower extremity lymphedema should be encouraged to undergo CDP, even when it is mild.
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<b>Introduction:</b> We report three cases of women who developed secondary lower-extremity lymphedema after surgery for endometrial cancer. The cancer stage was 2 as per the International Society of Lymphology risk stratification. <b>Case Reports:</b> We performed intensive lymphdrainage of two-phase complex decongestive physiotherapy in each case during a 1-week hospitalization period. The average leg circumference at discharge improved to 92～96% from baseline. Case 1: After primary treatment, a 35-year-old woman presented with temporarily poor self lymphatic drainage during maintenance therapy, and her leg circumference progressively enlarged. However, the patient received reeducation for self lymphatic drainage and outpatient service for lymphedema regularly. Since then, the leg lymphedema has improved. Case 2: A 63-year old woman improved to 92% of baseline and continued an excellent self lymphatic drainage, maintaining 83% with her depression recovered 2.5 years after this hospitalization. Case 3: This case involved a 70-year-old woman in whom maintenance therapy progressed well without aggravation of lymphedema; however, she died in 1.2 years after the first phase treatment due to cancer recurrence. <b>Discussion:</b> Intensive care under short-term hospitalization (for one week) for lower-extremity lymphedema was effective. However, there was one patient in whom self lymphatic drainage became poor. The patients required long-term care for maintenance therapy after primary treatment.
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OBJECTIVE: To evaluate the usefulness of ultrasonography as a follow-up tool for evaluating the effects of complex decongestive physiotherapy (CDPT) in breast cancer-related lymphedema (BCRL). METHODS: Twenty patients with BCRL were enrolled in this study. All patients had undergone therapy in the CDPT program for 2 weeks. Soft tissue thickness of both the affected and unaffected upper limb was measured before and after CDPT. The measurements were taken at 3 points (the mid-point between the medial and lateral epicondyles at the elbow level, 10 cm proximal and 10 cm distal to the elbow) with and without pressure. We then calculated the compliance of soft tissue before and after CDPT. Circumferences of both the affected and unaffected upper limb were also measured before and after CDPT at the 3 defined points. RESULTS: After 2 weeks of the CDPT program, the circumference and soft tissue thickness of the unaffected upper limb did not significantly change. In the affected upper limb, the circumference was significantly reduced in the 3 point, when compared with measurements taken prior to treatment. Additionally, soft tissue thickness was significantly reduced at the elbow and 10 cm proximal to the elbow. After CDPT, compliance at each of the 3 points had increased, but this trend was not significantly different. CONCLUSION: Our results showed that arm circumference and ultrasonography-derived soft tissue thickness was useful as a way of assessing therapeutic effects of CDPT.
Subject(s)
Humans , Arm , Breast , Compliance , Elbow , Follow-Up Studies , Lymphedema , Ultrasonography , Upper ExtremityABSTRACT
OBJECTIVE: To investigate the effects of complex decongestive physiotherapy (CDPT) with sodium selenite compared to the effects of CDPT without sodium selenite for the treatment of breast cancer-related lymphedema (BCRL). METHOD: Patients (n=40) who were diagnosed with BCRL were randomly assigned to the two groups: sodium selenite group or the non-sodium selenite group. In the sodium selenite group, sodium selenite was administered for 100 days concurrently with CDPT. In the non-sodium selenite group, only CDPT was administered. The main outcome measurements included limb circumference (proximal, distal and total) to indicate volume changes, the visual analogue scale (VAS) and the short form-36 version 2 questionnaire (SF-36) scores to evaluate the quality of life (QoL) pre-treatment, 100 days post-treatment and 130 days post-treatment for each patient. RESULTS: The sodium selenite group experienced volume reduction of 8.22% and 9.21%, at 100 and 130 days post-treatment, respectively. The non-sodium selenite group experienced 5.57% and 6.11% reduction in swelling at the same periods. Between the two groups, more significant volume reduction was observed in the affected distal limbs of patients assigned to the sodium selenite group compared to patients in the non-sodium group. However, the VAS and the SF-36 scores were not significantly different between the two groups. CONCLUSION: Sodium selenite therapy in combination with CDPT is effective in reducing the volume of upper limb in BCRL, and significantly reduce the volume of the affected distal upper limb compared to CDPT alone.