Reduction of Unilateral Upper Extremity Lymphedema Secondary to Breast Cancer: A 36 Month Follow-Up of Patients Treated With Non-Invasive Complex Lymphedema Therapy
Bonnie B. Lasinski, P.T., Marvin Boris, M.D., Lymphedema Therapy, Woodbury, New York
A prospective study of 63 consecutive patients with unilateral upper extremity lymphedema secondary to axillary node dissection (accompanying lumpectomy or mastectomy for carcinoma of the breast) was done to evaluate the persistence of reduction in lymphedema following a single course of Complex Lymphedema Therapy.
CLT consists of lymphatic drainage, compression bandaging, skin care, and patient specific physical therapy exercises. The basic concept of CLT is to maximize central lymphatic drainage. This is accomplished by opening collateral vessels to channel peripheral lymph into normally functioning lymphotomes. Sixty-three patients (60 female and 3 male) were followed. Twenty-seven had lumpectomies with axillary node dissection and thirty-six had mastectomies with axillary node dissection. Analysis was made at six, twelve, twenty-four, and thirty-six months post CLT. The average reduction following four weeks of CLT was 62.5%. This increased to 68.3% at six months, to 65.8% at twelve months, to 65.9% at twenty-four months, and to 87.1% at thirty-six months respectively. In our study, compliance was evaluated by the percent of time the patient wore their prescribed compression garment and their adherence to special physical therapy exercises. No additional courses of CLT were administered to our study group. In those individuals who were 100% compliant, their reductions increased to 79.0%. The non-compliant individuals had their reductions reduced to 30.8% from the initial 62.5%.
In summary, CLT affords excellent reduction of lymphedema secondary to breast cancer. Over a 36 month follow-up period, without regard to compliance, the reductions obtained through CLT had been increased. When the reductions were evaluated by compliance, those patients who were compliant, markedly increased their reductions, while the non-compliant patients lost a percentage of their initial reduction, which was directly related to the percent of their compliance.
Marvin Boris, MD