Can manual treatment of lymphedema promote metastasis?

J Soc Integr Oncol. 2006 Winter;4(1):8-12.

Godette K, Mondry TE, Johnstone PA.

Complete decongestive therapy (CDT; alternatively known as complete decongestive physiotherapy) is a treatment program for patients diagnosed with primary or secondary lymphedema. CDT incorporates manual lymphatic drainage (MLD), a technique involving therapeutic manipulation of the affected limb. There are several contraindications to performing CDT. Relative contraindications include hypertension, paralysis, diabetes, and bronchial asthma. General contraindications include acute infections of any kind and congestive heart failure. Malignant disease is also widely considered a general contraindication; a current vogue concept is that MLD will lead to dissemination and acceleration of cancer. However, cancer research supports the contention that this therapy does not contribute to spread of disease and should not be withheld from patients with metastasis. The intent of this article is to review these data.

PMID: 16737666 [PubMed - in process]

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Decongestive lymphatic therapy for patients with cancer-related or primary lymphedema.

Szuba A, Cooke JP, Yousuf S, Rockson SG.Stanford Lymphedema Center, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.

PURPOSE:

A prospective evaluation was undertaken to assess the efficacy of intensive, short-term decongestive lymphatic therapy coupled with focused patient instruction in long-term self-care for the management of lymphedema.

METHODS:

The therapeutic responses of 79 patients with lymphedema were analyzed prospectively. Each patient received intensive, short-term decongestive lymphatic therapy, with quantification of the extent and durability of the clinical response. Decongestive lymphatic therapy was performed by therapists trained in these techniques. The mean (+/-SD) duration of therapy was 8+/-3 days. Instruction in self-management techniques was incorporated into the therapeutic regimen by day 3 of the patient's treatment. The mean period of follow-up was 38+/-52 days. Changes in the volume of the affected limb were assessed with a geometric approximation derived from serial measurements of circumference along the axis of the limb.

RESULTS:

The mean short-term reduction in limb volume was 44%+/-62% of the excess volume in the upper extremities and 42%+/-40% in the lower extremities. At follow-up, these results were adequately sustained: mean long-term excess volume reductions of 38%+/-56% (upper extremities) and 41%+/-27% (lower extremities) were observed. CONCLUSION: Decongestive lymphatic therapy, combined with long-term self-management, is efficacious in treating patients with lymphedema of the extremity.

Publication Types:
Evaluation Studies

PMID: 10996580 [PubMed - indexed for MEDLINE]

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Spread of melanoma after lymphatic drainage: relaunching the debate.

Vereecken P, Mathieu A, Laporte M, Petein M, Heenen M.Department of Dermatology, Erasme Hospital, Free University of Brussels, Brussels, Belgium.

Secondary lymphoedema of the leg can result in disruption of lymphatic vessels following lymph node surgery. Evidence supports the use of complex decongestive physiotherapy (CDP) in such cases, despite the possibility of tumour recurrence due to this therapy in cancer patients. We present the case of a 52-year-old woman who developed in-transit metastases and systemic evaluable disease one month after starting CDP for secondary lymphoedema of the leg.

Publication Types:
Case ReportsPMID: 12846356 [PubMed - indexed for MEDLINE]