Original research| Volume 97, ISSUE 9, P1520-1525, September 2016

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

Published:March 14, 2016DOI:



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


      Prospective clinical pilot study.


      Education and research hospital.


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


      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.


      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).


      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.


      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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        • Serizawa F.
        • Ito K.
        • Matsubara M.
        • Sato A.
        • Shimokawa H.
        • Satomi S.
        Extracorporeal shock wave therapy induces therapeutic lymphangiogenesis in a rat model of secondary lymphoedema.
        Eur J Vasc Endovasc Surg. 2011; 42: 254-260
        • Irdesel J.
        • Çeliktas S.K.
        Effectiveness of exercise and compression garments in the treatment of breast cancer related lymphedema.
        Turk J Phys Med Rehabil. 2007; 53: 16-21
        • Bakar Y.
        • Berdici B.
        • Sahin N.
        • Pala O.O.
        Lymphedema after breast cancer and its treatment.
        J Breast Health. 2014; 10: 6-14
        • Başaran S.
        • Kozanoğlu E.
        Breast cancer related lymphedema and conservative therapies.
        Turk J Phys Med Rehabil. 2009; 55: 29-34
        • Moattari M.
        • Jaafari B.
        • Talei A.
        • Piroozi S.
        • Tahmasebi S.
        • Zakeri Z.
        The effect of combined decongestive therapy and pneumatic compression pump on lymphedema indicators in patients with breast cancer related lymphedema.
        Iran Red Crescent Med J. 2012; 14: 210-217
        • Hwang J.M.
        • Hwang J.H.
        • Kim T.W.
        • Lee S.Y.
        • Chang H.J.
        • Chu I.H.
        Long-term effects of complex decongestive therapy in breast cancer patients with arm lymphedema after axillary dissection.
        Ann Rehabil Med. 2013; 37: 690-697
        • Finnane A.
        • Janda M.
        • Hayes S.C.
        Review of the evidence of lymphedema treatment effect.
        Am J Phys Med Rehabil. 2015; 94: 483-498
        • Koul R.
        • Dufan T.
        • Russell C.
        • et al.
        Efficacy of complete decongestive therapy and manual lymphatic drainage on treatment-related lymphedema in breast cancer.
        Int J Radiat Oncol Biol Phys. 2007; 67: 841-846
        • Devoogdt N.
        • Van Kampen M.
        • Geraerts I.
        • Coremans T.
        • Christiaens M.R.
        Different physical treatment modalities for lymphoedema developing after axillary lymph node dissection for breast cancer: a review.
        Eur J Obstet Gynecol Reprod Biol. 2010; 149: 3-9
        • Tiwari P.
        • Coriddi M.
        • Salani R.
        • Povoski S.P.
        Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options.
        World J Surg Oncol. 2013; 11: 237
        • Carati C.J.
        • Anderson S.N.
        • Gannon B.J.
        • Piller N.B.
        Treatment of postmastectomy lymphedema with low-level laser therapy: a double blind, placebo-controlled trial.
        Cancer. 2003; 98: 1114-1122
        • Kaviani A.
        • Fateh M.
        • Yousefi Nooraie R.
        • Alinagi-zadeh M.R.
        • Ataie-Fashtami L.
        Low-level laser therapy in management of postmastectomy lymphedema.
        Lasers Med Sci. 2006; 21: 90-94
        • Cassileth B.R.
        • Van Zee K.J.
        • Yeung K.S.
        • Coleton M.I.
        • Cohen S.
        • Chan Y.H.
        Acupuncture in the treatment of upper-limb lymphedema: results of a pilot study.
        Cancer. 2013; 119: 2455-2461
        • Tsai H.J.
        • Hung H.C.
        • Yang J.L.
        • Huang C.S.
        • Tsauo J.Y.
        Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study.
        Support Care Cancer. 2009; 17: 1353-1360
        • Kubo M.
        • Li T.S.
        • Kamota T.
        • Ohshima M.
        • Shirasawa B.
        • Hamano K.
        Extracorporeal shock wave therapy ameliorates secondary lymphedema by promoting lymphangiogenesis.
        J Vasc Surg. 2010; 52: 429-434
        • Bae H.
        • Kim H.J.
        Clinical outcomes of extracorporeal shock wave therapy in patients with secondary lymphedema: a pilot study.
        Ann Rehabil Med. 2013; 37: 229-234
        • Romeo P.
        • Lavanga V.
        • Pagani D.
        • Sansonie V.
        Extracorporeal shock wave therapy in musculoskeletal disorders: a review.
        Med Princ Pract. 2014; 23: 7-13
        • Wang C.J.
        An overview of shock wave therapy in musculoskeletal disorders.
        Chang Gung Med J. 2003; 26: 220-232
        • Kim S.J.
        • Yi C.H.
        • Kwon O.Y.
        Effect of complex decongestive therapy on edema and the quality of life in breast cancer patients with unilateral lymphedema.
        Lymphology. 2007; 40: 143-151
        • Taghian N.R.
        • Miller C.L.
        • Jammallo L.S.
        • O'Toole J.
        • Skolny M.N.
        Lymphedema following breast cancer treatment and impact on quality of life: a review.
        Crit Rev Oncol Hematol. 2014; 92: 227-234
        • Meneses K.D.
        • McNees M.P.
        Upper extremity lymphedema after treatment for breast cancer: a review of the literature.
        Ostomy Wound Manage. 2007; 53: 16-29
        • Martins da Silva R.C.
        • Rezende L.F.
        Assessment of impact of late postoperative physical functional disabilities on quality of life in breast cancer survivors.
        Tumori. 2014; 100: 87-90
        • Uzkeser H.
        Assessment of postmastectomy lymphedema and current treatment approaches.
        Eur J Gen Med. 2012; 9: 130-134
        • Oliveira I.S.
        • Costa L.C.
        • Manzoni A.C.
        • Cabral C.M.
        Assessment of the measurement properties of quality of life questionnaires in Brazilian women with breast cancer.
        Braz J Phys Ther. 2014; 18: 372-383
        • Eser E.
        • Fidaner H.
        • Fidaner C.
        WHOQOL-BREF TR: a suitable instrument fot the assesment of quality of life for use in health care settings in Turkey.
        Qual Life Res. 1999; 8: 647