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Extracorporeal Shock Wave Therapy for Breast Cancer–Related Lymphedema: A Pilot Study

Published:March 14, 2016DOI:https://doi.org/10.1016/j.apmr.2016.02.019

      Abstract

      Objective

      To investigate the clinical effect of extracorporeal shock wave therapy (ESWT) in patients with secondary lymphedema after breast cancer treatment.

      Design

      Prospective clinical pilot study.

      Setting

      Education and research hospital.

      Participants

      Women with a diagnosis of lymphedema secondary to breast cancer (N=11).

      Interventions

      Patients were treated for 12 sessions of ESWT with 2500 impulses each. The treatment frequency was 4Hz in multiple shock mode. The energy flow density during treatment was equal to a working pressure of 2 bar.

      Main Outcome Measures

      The primary outcome measure was volumetric measurements. The secondary outcome measures were the short version of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH) and the brief version of the World Health Organization Quality of Life (WHOQOL-BREF). Assessments were conducted by the same investigator at baseline, posttreatment, and at 1, 3, and 6 months after treatment for all patients.

      Results

      Significant reduction was found in the amount of lymphedema with ESWT treatment in all patients, and this reduction was maintained for 6 months. A statistically significant reduction was observed in volumetric measurements for the follow-up period (P=.001). The mean volume displacement of the affected upper extremity before treatment was 870.45±384.19mL at 6 months, and after the treatment it was 604.54±381.74mL. In addition, improvements were observed in the QuickDASH functional assessment tool and in the physical health domain of the WHOQOL-BREF questionnaire (P=.002 and P=.007, respectively).

      Conclusions

      ESWT was shown to provide a reduction in the amount of lymphedema in patients with lymphedema secondary to breast cancer. Also, a marked improvement was observed in the functional status and quality of life of study patients. Treatment efficacy was maintained in the long term. As a noninvasive, novel, and effective method, ESWT is a promising treatment modality for the treatment of lymphedema, which is a chronic, progressive, and refractory condition.

      Keywords

      List of abbreviations:

      CDT (complex decongestive therapy), ESWT (extracorporeal shock wave therapy), QOL (quality of life), QuickDASH (short version of the Disabilities of the Arm, Shoulder and Hand Questionnaire), VEGF (vascular endothelial growth factor), WHOQOL-BREF (brief version of the World Health Organization Quality of Life)
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