The Lymphedema Chaos: A Lancet

Földi, Etel; Földi, M; Clodius, L.

doi:10.1097/00000637-198906000-00007

Cited by 171 publications

(55 citation statements)

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“…Conversely, we were unable to validate published claims that IPC has a deleterious effect on patients who receive prior treatment for lymphedema. 28,29 The current investigation suggests that the use of IPC can be used effectively in the therapeutic approach to patients with breast carcinoma-associated lymphedema. In view of the important psychosocial ramifications of breast carcinoma-associated lymphedema, 4 the ease of application of IPC as a long-term therapeutic intervention suggests that it may warrant more widespread use in this patient population.…”

Section: Discussionmentioning

confidence: 93%

Decongestive lymphatic therapy for patients with breast carcinoma‐associated lymphedema

Szuba

Achalu

Rockson

2002

Cancer

185

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BACKGROUNDDisruption of the lymphatic circulation through breast carcinoma‐associated axillary lymph node dissection, with or without radiation therapy, reportedly is the most common cause of lymphedema in developed countries. There is no cure for breast carcinoma‐associated lymphedema. Although intermittent pneumatic compression (IPC) has been acknowledged as a potential component of the multidisciplinary therapeutic strategy in the treatment of patients with breast carcinoma‐associated lymphedema, prospective study of its adjunctive safety and efficacy is required.METHODSIPC was assessed as a component of the initial therapeutic regimen for newly treated patients with breast carcinoma‐associated lymphedema. Twenty‐three patients who had not previously been treated for lymphedema were randomized to receive either decongestive lymphatic therapy (DLT) alone or DLT with daily adjunctive IPC. Patients with stable, treated, breast carcinoma‐associated lymphedema also were assessed in the maintenance phase of therapy. Twenty‐seven patients were randomized either to DLT alone or to DLT coupled with daily IPC. In both studies, objective assessment included serial measurement of volume by water displacement, tissue tonometry to assess elasticity of the skin, and goniometry to measure joint mobility.RESULTSDuring initial treatment, the addition of IPC to standard DLT yielded an additional mean volume reduction (45.3% vs. 26%; P < 0.05). During maintenance DLT alone, there was a mean increase in volume (32.7 ± 115.2 mL); with DLT and IPC, there was a mean volume reduction (89.5 ± 195.5 mL; P < 0.05). In both studies, IPC was tolerated well without detectable adverse effects on skin elasticity or joint range of motion.CONCLUSIONSWhen IPC is used adjunctively with other, established elements of DLT, it provides an enhancement of the therapeutic response. IPC is well tolerated and remarkably free of complications. Cancer 2002;95:2260–7. © 2002 American Cancer Society.DOI 10.1002/cncr.10976

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Section: Discussionmentioning

confidence: 93%

Decongestive lymphatic therapy for patients with breast carcinoma‐associated lymphedema

Szuba

Achalu

Rockson

2002

Cancer

185

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“…Although this might create a bias when selecting patients for LVA, the alternative is that many patients would have unnecessary operative treatment with perhaps detrimental effects. Most patients with early stages 1-3 of lymphedema can be treated successfully with CDT [22,23]. Moreover, in many studies information is missing about the follow-up protocol and many do not report whether or not elastic stockings are mandatory after an LVA procedure.…”

Section: Discussionmentioning

confidence: 99%

“…According to stages 1 to 3, conservative treatment of lymphedema is sufficient in most patients [22,23]. In stage 3 lymphedema, the pitting component can often be treated successfully; however the fibrosis and access of adipose tissue will remain.…”

Section: Discussionmentioning

confidence: 99%

Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

Damstra

Voesten

Schelven

et al. 2008

Breast Cancer Res Treat

166

149

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Objective The incidence of breast cancer related lymphedema (BCRL) varies between 7-35% depending on the combination of treatment modalities. Early detection of BCRL is crucial in order to start an effective non-operative treatment program. Because of the lack of prospective research on this topic, this study was undertaken to prospectively determine the effect of Lympho Venous Anastomosis (LVA) on BCRL and to review the current literature. Study design and methods Ten patients who were previously treated for breast cancer by surgery, radiotherapy, and chemotherapy, and were unresponsive to 12-weeks of non-operative treatment, underwent an LVA procedure (Degni-Cordeiro). Objective measurements were gathered for circumferential measurement and water volumetry, and quality of life. Various types of lymphoscintigraphy were carried out pre-operatively and post-operatively at 3 and 12 months. Treatment was embedded in a multidisciplinary setting. Results Post-operative volume measurements initially showed a 4.8% reduction of lymphedema at 3 months and a 2% reduction after one year. Various scintigraphic parameters showed some improvement. Quality of life questionnaires reported minimal improvement. Reviewing the literature, only retrospective studies were found; these reported varying results for LVA procedures. The selection of patients, classification of lymphedema, indications and types of LVA, and additional therapeutic options were heterogeneous, not comparable, and lacked a validated method of effect-assessment. Conclusions Our results showed a minimal reduction in volume of lymphedema following LVA; in the literature, there was no convincing evidence of the success of LVA. Non-operative treatment and elastic stockings are still preferred by most patients with lymphedema, especially in early stages with few irreversible changes.Keywords Lympho-venous anastomosis (LVA) Á Microsurgery Á Evidence-based medicine Á Lymphoscintigraphy Á Inverse water volumetry Á Review Á Breast cancer related lymphedema

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“…[170,173] . In experimental studies in rat, dog, and rabbit extremities, the multi-layers of lymph vascular networks, the rapid development of a good collateral network, and sufficient angiogenesis permit quick restoration of lymph pathways and drainage function, leading to prompt resolution of even acute edema without the appearance of long-term or chronic edema [174][175][176][177] . This precludes an informed study of chronic or long-term edema.…”

Section: Study Of Experimental Lymphedemamentioning

confidence: 99%

Advances in small animal mesentery models for in vivo flow cytometry, dynamic microscopy, and drug screening

Galanzha¹

2007

WJG

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Using animal mesentery with intravital optical microscopy is a well-established experimental model for studying blood and lymph microcirculation in vivo . Recent advances in cell biology and optical techniques provide the basis for extending this model for new applications, which should generate significantly improved experimental data. This review summarizes the achievements in this specific area, including in vivo label-free blood and lymph photothermal flow cytometry, super-sensitive fluorescence image cytometry, light scattering and speckle flow cytometry, microvessel dynamic microscopy, infrared (IR) angiography, and high-speed imaging of individual cells in fast flow. The capabilities of these techniques, using the rat mesentery model, were demonstrated in various studies; e.g., real-time quantitative detection of circulating and migrating individual blood and cancer cells, studies on vascular dynamics with a focus on lymphatics under normal conditions and under different interventions (e.g. lasers, drugs, nicotine), assessment of lymphatic disturbances from experimental lymphedema, monitoring cell traffic between blood and lymph systems, and high-speed imaging of cell transient deformability in flow. In particular, the obtained results demonstrated that individual cell transportation in living organisms depends on cell type (e.g., normal blood or leukemic cells), the cell's functional state (e.g., live, apoptotic, or necrotic), and the functional status of the organism. Possible future applications, including in vivo early diagnosis and prevention of disease, monitoring immune response and apoptosis, chemo-and radio-sensitivity tests, and drug screening, are also discussed. TOPIC HIGHLIGHT

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The Lymphedema Chaos: A Lancet

Cited by 171 publications

References 0 publications

Decongestive lymphatic therapy for patients with breast carcinoma‐associated lymphedema

Decongestive lymphatic therapy for patients with breast carcinoma‐associated lymphedema

Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

Advances in small animal mesentery models for in vivo flow cytometry, dynamic microscopy, and drug screening

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