Manipulative therapy of secondary lymphedema in the presence of locoregional tumors

Abstract

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. © 2007 American Cancer Society.

Systematic review: conservative treatments for secondary lymphedema

“…Of the 36 English-language studies, 30 were RCTs [11,21-41,43-50] and six were observational (cohort) [51-56]. Fifteen RCTs were fair quality [21,22,25,26,29-32,36,43-47,50], eight were good quality [11,24,27,35,38,41,48,49], and seven were poor quality [23,28,33,34,37,39,40].…”

Connecting (T)issues: How Research in Fascia Biology Can Impact Integrative Oncology

“…There is also controversy over the role and safety of manual therapies and acupuncture in the management of lymphedema postcancer treatment (64,65). Although some studies have concluded that such treatment is safe even in areas with residual tumor (66)(67)(68), to date, no randomized prospective study has examined this issue. Meanwhile, there is virtually no basic research on physical manipulation of the connective tissue matrix surrounding tumors to influence the behavior of the tumor as it interacts with its surrounding matrix, or at distant sites to influence the receptivity of the matrix to metastatic seeding.…”

Daganatos betegekben kialakult másodlagos nyiroködéma ellátása

“…Ha az onkológiai kezelés palliatív célból történik, palliatív ödé-mamentesítésről beszélünk, amely szükség esetén kiegé-szítendő palliatív sebkezeléssel és fájdalomcsillapítással. Számos szerző érvel amellett, hogy a manuális drenálás végzése nem kontraindikált áttétes tumor fennállása esetén, de ilyen esetben a manuális drenálást az adott helyzethez kell adaptálni [15][16][17][18][19]. Elméletileg ugyan a nyirokkollektorokban már jelen lévő tumorthrombusokat befolyásolhatja a manuális drenálás vagy a kompresszió, de a nemzetközi konszenzus is elismerte a KÖK alkalmazásának palliatív előnyeit aktív tumor fennállásakor [11].…”

“…Ilyen módosítások lehetnek: a tumor vagy áttét által érintett bőrterületek elkerülése a manuális drenálás során; a standard kezeléshez képest alacsonyabb nyomással felhelyezett fásli; a kifekélyesedő tumor sebellátása; plegiás vég-tagra adaptált gyógytorna stb. Pinell és mtsai által végzett klinikai vizsgálat szerint a KÖK lokoregionális tumor fennállása esetén is ugyanolyan hatékonynak bizonyult, bár hosszabb kezelési időre volt ehhez szükség, mint tumormentes szekunder nyiroködémás betegekben [18].…”