Predictive factors of response to intensive decongestive physiotherapy in upper limb lymphedema after breast cancer treatment: a cohort study.

摘要

BACKGROUND: Lymphedema is a frequent complication after breast cancer treatment. Reduction of lymphedema volume is obtained during an intensive phase with daily physiotherapy. Response to treatment remains unknown prior treatment. We purposed to analyze predictors of response of lymphedema treatment throughout the first course of physiotherapy. DESIGN: Patients with secondary arm lymphedema were recruited in a single lymphology unit between 2001 and 2004. For each patient, the following data were recorded: characteristics of breast cancer treatment, patient characteristics, body mass index and lymphedema volume prior and at the end of treatment. RESULTS: Three hundred and fifty-seven women (mean age: 53+/-11 years) were included. Initial excess volume of lymphedema was correlated to body mass index and duration of lymphedema. Mean duration of intensive decongestive therapy was 11.8+/-3.3 days. Mean excess volume of lymphedema was 1067+/-622 ml prior treatment and 663+/-366 ml after treatment (p<0.001),percentage of excess volume of lymphedema was 59+/-34% and 36+/-19%, respectively. Absolute volume reduction was 404+/-33 ml (p<0.001). Body mass index and duration of lymphedema before treatment were the two predictors of absolute reduction of lymphedema volume. Higher was the body mass index or the duration of lymphedema, more important was the absolute reduction of lymphedema volume. Mean relative percentage of volume reduction was 36+/-14% whatever mass index or the duration of lymphedema was. CONCLUSION: Duration of lymphedema from cancer treatment and body mass index were the only two predictors of absolute reduction of lymphedema volume after intensive decongestive physiotherapy. For all patients this latter treatment is highly effective in management of secondary upper limb lymphedema after breast cancer.