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Stanford
University School of Medicine
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By Steven Reinberg
NEW YORK (Reuters
Health) Dec 13, 2002 - Intermittent pneumatic compression (IPC) added to other
elements of decongestive lymphatic therapy enhances the treatment of lymphedema
associated with axillary lymph node dissection in breast cancer patients,
researchers report in the December 1st issue of Cancer.
"Lymphedema of the arm is a common aftermath of breast cancer treatment with
surgery and radiation. The condition is debilitating, physically and
psychologically, and treatment options are quite limited," Dr. Stanley G.
Rockson told Reuters Health.
He added that the use of pneumatic compression pumps as a potential treatment
has fallen into disfavor because of old, poorly substantiated claims that
the use of pumps can actually create more problems than they solve.
"Our study is the first prospective evaluation of the use of these pumps as
adjunctive therapy to the existing physiotherapies for breast cancer lymphedema,
both in acute and maintenance management. We evaluated both efficacy and the
potential for creating side effects," Dr. Rockson explained.
He and his colleagues
from Stanford University School of Medicine, California, assessed the use of IPC
in 23 women who had not received previous treatment for lymphedema. The women
were randomized to decongestive lymphatic therapy alone or in combination with
IPC.
In a second trial,
the researchers randomly assigned 27 women who had received previous treatment
for lymphedema to daily treatment with decongestive lymphatic therapy alone or
along with IPC.
Overall, combined therapy resulted in a mean volume reduction of 45.3% compared
with 26% for decongestive lymphatic therapy alone, the researchers report. In
maintenance therapy, decongestive lymphatic therapy plus IPC resulted in a
reduction of mean volume of 89.5 mL compared with an increase of 32.7 mL with
decongestive lymphatic therapy alone.
"Our study documents efficacy in both acute and chronic maintenance, when added
to conventional measures. There is no evidence that the therapy creates
complications in the skin or the joints, as previously alleged," Dr. Rockson
said.
He concludes that IPC is a very safe and
cost-efficient method of treatment that has been inappropriately neglected; and
may actually be a very effective way to improve the well-being of a large number
of patients with this common disease that is currently under treated.
Cancer 2002; 95:2260-2267.
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Presented here are abstracts from a recently completed study by the Stanford University Center for Lymphatic and Venous Disorders. The study evaluates the use of Pneumatic Sequential Compression for the treatment of postmastectomy lymphedema.
The Stanford University Center for Lymphatic and Venous Disorder is the foremost institution in the country studying the treatment of lymphedema. Bio Compression pumps were used exclusively in this study.
AN EVALUATION OF ADJUNCTIVE INTERMITTENT PNEUMATIC COMPRESSION IN THE ACUTE TREATMENT OF POSTMASTECTOMY LYMPHEDEMA
A. Szuba,
MD, PhD, R. Ashalu, MD, S.G. Rockson, MD
Stanford Center for Lymphatic and Venous Disorders,
Stanford University School of Medicine, Stanford, CA USA
Srockson@cvmed.stanford.edu
We investigated the safety and efficacy of adjunctive intermittent pneumatic compression (IPC) for the acute decongestive therapy of post-mastectomy lymphedema. Twenty-three patients were randomized to decongestive lymphatic therapy (DLT) with (Group II) or without (Group I) IPC. DLT included manual lymphatic drainage, bandaging, and exercise, performed daily. In Group II, 30 minutes of IPC was performed daily at 40-50 mm Hg. Arm volume was assessed by tank volumetry.
In Group I, the 11 patients achieved 26% acute arm volume reduction; in Group II, the 12 patients achieved a mean volume reduction of 45.3% (p,<0.05). There were no complications attributable to either DLT or IPC.
Conclusion:, IPC is generally safe and well-tolerated and appears to provide synergistic benefit when used with DLT in the acute decompressive approach to post–mastectomy lymphedema.
EVALUATION OF INTERMITTENT PNEUMATIC COMPRESSION AS ADJUNCTIVE MAINTENANCE THERAPY IN POSTMASTECTOMY LYMPHEDEMA
A. Szuba,
MD, PhD, R. Achalu, MD, S.G. Rockson, MD
Stanford Center for Lymphatic and Venous Disorders,
Stanford
University School of Medicine, Stanford, CA USA
Srockson@cvmed.stanford.edu
We studied the safety and efficacy of intermittent pneumatic compression therapy as an adjunct to standard decongestive lymphatic therapy in patients with stable post-mastectomy arm lymphedema.
Study design: Randomized, cross-over, 2 month study with 6 month follow-up
Patients and methods: 29 patients with postmastectomy arm lymphedema and without evidence of active cancer were enrolled. Patients were randomized into two groups.
Patients assigned to Group I were asked to continue their routine maintenance therapy with use of a Class II compression garment and self–applied manual lymphatic drainage (MLD); patients assigned to Group II were asked to use the intermittent pneumatic compression (IPC) pump for 1 hour daily (40-50mmHg) in addition to conventional therapy (garments + MLD).
All patients crossed over to the alternate therapy after one month. Patients who elected to continue chronic use of the pump were evaluated after 6 months. Clinical evaluation was performed at the beginning of the study, after the first and the second month and after six month follow-up. The evaluation included tank volumetry, skin tonometry, and measurement of range of motion.
Results: 27 patients completed the study. Two patients voluntarily withdrew.
There was a mean volume reduction of 89.5 ml during the month with IPC and volume increase of 32.7 ml during the month of routine maintenance therapy.
The difference was statistically significant (p<0.05). There was no difference in tonometry results. Of the 21 patients who completed chronic use of IPC, 19 were available for analysis.
After 6 months, there was a further average volume reduction of 29.1 ml (not statistically significant). No adverse effects of IPC were observed.
Conclusion: Intermittent pneumatic compression is safe and well tolerated and may offer additional benefit for patients with postmastectomy lymphedema.
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