Physiotherapeutic stimulation: Early prevention of lymphedema following axillary lymph node dissection for breast cancer treatment

Sarri,Almir J.; Moriguchi,Sonia M.; Dias,Rogério; Peres,Stela V.; Da Silva,Eduardo T.; Koga,Kátia H.; Matthes,Ângelo G.Z.; Dos Santos,Marcelo J.; Da Rocha,Euclides T.; Haikel,Raphael L.

doi:10.3892/etm_00000024

Physiotherapeutic stimulation: Early prevention of lymphedema following axillary lymph node dissection for breast cancer treatment

Authors:
- Almir J. Sarri
- Sonia M. Moriguchi
- Rogério Dias
- Stela V. Peres
- Eduardo T. Da Silva
- Kátia H. Koga
- Ângelo G.Z. Matthes
- Marcelo J. Dos Santos
- Euclides T. Da Rocha
- Raphael L. Haikel
View Affiliations

Affiliations: Department of Physiotherapy, Barretos Cancer Hospital, São Paulo, Brazil. almirsarri@hotmail.com
Published online on: January 1, 2010 https://doi.org/10.3892/etm_00000024
Pages: 147-152

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of this study was to confirm the effectiveness of early physiotherapeutic stimulation for lymphatic flow progression in patients with breast cancer undergoing axillary dissection. This was a randomized experimental study on 22 patients who underwent lymphoscintigraphy in their arms on two different occasions, firstly without stimulation and secondly after randomization into two groups: without physiotherapeutic stimulation (WOPS; n=10) and with physiotherapeutic stimulation (WPS; n=12). The lymphoscintigraphy scan was performed with 99mTc-phytate administered into the second interdigital space of the hand, ipsilaterally to the dissected axilla, in three phases: dynamic, static, and delayed whole body imaging. Physiotherapeutic stimulation was carried out using Földi's technique. In both groups, images from the two examinations of each patient were compared. Flow progression was considered positive when, on the second examination, the radiopharmaceutical reached areas more distant from the injection site. Statistical analysis was used to evaluate frequencies, percentages and central trend measurements, and non-parametric tests were conducted. Descriptive analysis showed that the WPS and WOPS groups were similar in terms of mean age, weight, height, body mass index and number of lymph nodes removed. There were statistically significant associations between physiotherapeutic stimulation and radiopharmaceutical progression at all three phases of the study (p<0.0001). Early physiotherapeutic stimulation in breast cancer patients undergoing radical axillary dissection is effective, and can therefore be indicated as a preventive measure against lymphedema.

View Figures

View References

1.	National Cancer Institute (NCI), USA: Progress shown in death rates from four leading cancers: decline in overall mortality has slowed (monograph on the Internet). Available from: http://www.nci.nih.gov/newscenter/pressreleases/2003ReportReleaseuri. Cited March 2004.
2.	Instituto Nacional do Câncer (INCA): Estimativa 2008: incidência de câncer no Brasil. INCA, Rio de Janeiro,. 2008
3.	Johansson S, Svensson H and Denekamp J: Dose response and latency for radiation-induced fibrosis, edema and neuropathy in breast cancer patients. Int J Radiot Oncol Biol Phys. 52:1207–1219. 2002. View Article : Google Scholar : PubMed/NCBI
4.	Bergmann A, Mattos IE and Koifman RJ: Diagnóstico do linfedema: análise dos métodos empregados na avaliação do membro superior após linfadenectomia axilar para tratamento do câncer de mama. Rev Bras Canc. 50:311–320. 2004.
5.	Bourgeois P, Leduc O and Leduc A: Imaging techniques in the management and prevention of posttherapeutic upper limb edemas. Cancer. 83:2805–2813. 1998. View Article : Google Scholar : PubMed/NCBI
6.	Paci E, Cardiddi A, Bacilli A, et al: Long-term sequelae of breast. Tumori. 82:321–324. 1996.PubMed/NCBI
7.	Goffman TE, Laronga C, Wilson L and Elkins D: Lymphedema of the arm and breast in irradiated breast in cancer patients: risks in an era of dramatically changing axillary surgery. Breast J. 10:405–411. 2004. View Article : Google Scholar : PubMed/NCBI
8.	Carpentier PH: Physiopathologie des lymphoedèmes. Rev Med Interne. 23:S371–S374. 2002.
9.	Clodius L, Piller NB and Casley-Smith JR: The problems of lymphatic microsurgery for lymphedema. Lymphology. 14:69–76. 1981.PubMed/NCBI
10.	Filippetti M, Santoro E, Graziano F, Petric M and Rinaldi G: Modern therapeutic approaches to postmastectomy brachial lymphedema. Microsurgery. 15:604–610. 1994. View Article : Google Scholar : PubMed/NCBI
11.	Glass EC, Essner R and Giuliano AE: Sentinel node localization in breast cancer. Semin Nucl Med. 29:57–68. 1999. View Article : Google Scholar : PubMed/NCBI
12.	Didem K, Ufuk YS, Serdar S and Zümre A: The comparison of two different physiotherapy methods in treatment of lymphedema after breast surgery. Breast Cancer Res Treat. 93:49–54. 2005. View Article : Google Scholar : PubMed/NCBI
13.	Roucout S and Oliveira VM: Etiologia, prevenção e tratamento do linfedema pós-mastectomia. Med Reab. 49:11–15. 1999.
14.	Linnitt N: Lymphoedema: recognition, assessment and management. Br J Community Nurs. 10:S20–S26. 2005. View Article : Google Scholar : PubMed/NCBI
15.	Clodius L: Minimizing secondary arm lymphedema from axillary dissection. Lymphology. 34:106–110. 2001.PubMed/NCBI
16.	Bumpers HL, Best IM, Norman D and Weaver WL: Debilitating lymphedema of the upper extremity after treatment of breast cancer. Am J Clin Oncol. 25:365–367. 2002. View Article : Google Scholar : PubMed/NCBI
17.	Rietman JS, Dijkstra PT, Geertzen JHB, et al: Treatment-related upper limb morbidity 1 year after sentinel lymph node biopsy or axillary lymph node dissection for stage I or II breast cancer. Ann Surg Oncol. 11:1018–1024. 2004.
18.	Williams AF, Vadgama A, Franks PJ and Mortimer PS: A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema. Eur J Cancer Care. 11:254–261. 2002. View Article : Google Scholar : PubMed/NCBI
19.	Rich A: How to care for uncomplicated skin and keep it free of complications. Br J Community Nurs. 12:S6–S9. 2007. View Article : Google Scholar : PubMed/NCBI
20.	Hampton S: Elvarex compression garments in the management of lymphoedema. Br J Nurs. 12:925–926. 2003. View Article : Google Scholar : PubMed/NCBI
21.	King B: Diagnosis and management of lymphoedema. Nurs Times. 102:4749512006.
22.	Camargo MC and Marx AG: Linfoterapia. Reabilitação Física no Câncer de Mama. Editora Roca. (São Paulo). 98–99. 2000.
23.	Földi E, Földi M and Weissleder H: Conservative treatment of lymphoedema of the limbs. Angiology. 36:171–180. 1985.
24.	Szuba A, Shin WS, Strauss HW and Rockson S: The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med. 44:43–57. 2003.PubMed/NCBI
25.	Baulieu F, Baulieu JL, Secchi V, Dabiens J, Barsotti J and Itti R: Factorial analysis of dynamic lymphoscintigraphy in lower limb limphoedema. Nucl Med Comm. 10:109–119. 1989. View Article : Google Scholar : PubMed/NCBI
26.	Ferrandez JC, Laroche JP, Serin D, Felix-Faure C and Vinot JM: Aspects lymphoscintigraphiques des eddets du drainage lymphatique manuel. J Mal Vasc. 21:283–289. 1996.
27.	Perrymore WD and Harolds JA: Technetium-99m-Albumin Colloid Lymphoscintigraphy in postoperative lymphocele. J Nucl Med. 37:1517–1518. 1996.PubMed/NCBI
28.	Burnand KG, McGuinness CL, Lagattolla NR, Browse NL, El-Aradi A and Nunan T: Value of isotope lymphography in the diagnosis of lymphoedema of the leg. Br J Surg. 89:74–78. 2002. View Article : Google Scholar : PubMed/NCBI
29.	Bull RH, Fenton DA and Mortimer PS: Lymphatic function in the yellow nail syndrome. Br J Dermatol. 134:307–312. 1996. View Article : Google Scholar : PubMed/NCBI
30.	Macea JR and Fregnani JHTG: Anatomy of the thoracic wall, axilla and breast. Int J Morphol. 24:691–704. 2006. View Article : Google Scholar
31.	Kwan W, Jackson J, Weir LM, Dingee C, McGregor G and Olivotto IA: Chronic arm morbidity after curative breast cancer treatment: prevalence and impact no quality of life. J Clin Oncol. 20:4242–4248. 2002. View Article : Google Scholar : PubMed/NCBI
32.	Linnitt N: Complex skin changes in chronic oedemas. Br J Community Nurs. 12:S10–S15. 2007. View Article : Google Scholar : PubMed/NCBI
33.	Badger C, Preston N, Seers K and Mortimer P: Physical therapies for reducing and controlling lymphoedema of the limbs. Cochrane Database Syst Rev. CD0031412004.PubMed/NCBI
34.	Huit M: A guide to treating lymphoedema. Nurs Times. 96:42–43. 2000.
35.	Moseley AL, Carati CJ and Piller NB: A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. Ann Oncol. 18:639–646. 2007. View Article : Google Scholar : PubMed/NCBI
36.	Andersen L, Hojris I, Erlandsen M and Andersen J: Treatment of breast-cancer related lymphedema with or without manual lymphatic drainage – a randomized study. Acta Oncol. 39:399–405. 2000.
37.	Suami H, Pan WR and Taylor GI: Changes in the lymph structure of the upper limb after axillary dissection: radiographic and anatomical study in a human cadaver. Plast Reconstr Surg. 120:982–991. 2007. View Article : Google Scholar : PubMed/NCBI
38.	Suami H, Pan WR and Taylor GI: The lymphatic territories of the upper limb: anatomical study and clinical implications. Plast Reconstr Surg. 119:1813–1822. 2007. View Article : Google Scholar : PubMed/NCBI
39.	Tabibiazar R, Cheung L, Han J, et al: Inflammatory manifestations of experimental lymphatic insufficiency. PloS Med. 3:1114–1139. 2006. View Article : Google Scholar