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Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema: A randomized, prospective study of a role for adjunctive intermittent pneumatic compression

Identifieur interne : 000243 ( PascalFrancis/Curation ); précédent : 000242; suivant : 000244

Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema: A randomized, prospective study of a role for adjunctive intermittent pneumatic compression

Auteurs : Andrzej Szuba [États-Unis] ; Radha Achalu [États-Unis] ; Stanley G. Rockson [États-Unis]

Source :

RBID : Pascal:03-0050471

Descripteurs français

English descriptors

Abstract

BACKGROUND. Disruption of the lymphatic circulation through breast carcinoma-associated axillary lymph node dissection, with or without radiation therapy, reportedly is the most common cause of lymphedema in developed countries. There is no cure for breast carcinoma-associated lymphedema. Although intermittent pneumatic compression (IPC) has been acknowledged as a potential component of the multidisciplinary therapeutic strategy in the treatment of patients with breast carcinoma-associated lymphedema, prospective study of its adjunctive safety and efficacy is required. METHODS. IPC was assessed as a component of the initial therapeutic regimen for newly treated patients with breast carcinoma-associated lymphedema. Twenty-three patients who had not previously been treated for lymphedema were randomized to receive either decongestive lymphatic therapy (DLT) alone or DLT with daily adjunctive IPC. Patients with stable, treated, breast carcinoma-associated lymphedema also were assessed in the maintenance phase of therapy. Twenty-seven patients were randomized either to DLT alone or to DLT coupled with daily IPC. In both studies, objective assessment included serial measurement of volume by water displacement, tissue tonometry to assess elasticity of the skin, and goniometry to measure joint mobility. RESULTS. During initial treatment, the addition of IPC to standard DLT yielded an additional mean volume reduction (45.3% vs. 26%; P < 0.05). During maintenance DLT alone, there was a mean increase in volume (32.7 ± 115.2 mL); with DLT and IPC, there was a mean volume reduction (89.5 ± 195.5 mL; P < 0.05). In both studies, IPC was tolerated well without detectable adverse effects on skin elasticity or joint range of motion. CONCLUSIONS. When IPC is used adjunctively with other, established elements of DLT, it provides an enhancement of the therapeutic response. IPC is well tolerated and remarkably free of complications.
pA  
A01 01  1    @0 0008-543X
A02 01      @0 CANCAR
A03   1    @0 Cancer
A05       @2 95
A06       @2 11
A08 01  1  ENG  @1 Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema: A randomized, prospective study of a role for adjunctive intermittent pneumatic compression
A11 01  1    @1 SZUBA (Andrzej)
A11 02  1    @1 ACHALU (Radha)
A11 03  1    @1 ROCKSON (Stanley G.)
A14 01      @1 Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University School of Medicine @2 Stanford, California @3 USA @Z 1 aut. @Z 2 aut. @Z 3 aut.
A20       @1 2260-2267
A21       @1 2002
A23 01      @0 ENG
A43 01      @1 INIST @2 2701 @5 354000106847030020
A44       @0 0000 @1 © 2003 INIST-CNRS. All rights reserved.
A45       @0 30 ref.
A47 01  1    @0 03-0050471
A60       @1 P
A61       @0 A
A64 01  1    @0 Cancer
A66 01      @0 USA
C01 01    ENG  @0 BACKGROUND. Disruption of the lymphatic circulation through breast carcinoma-associated axillary lymph node dissection, with or without radiation therapy, reportedly is the most common cause of lymphedema in developed countries. There is no cure for breast carcinoma-associated lymphedema. Although intermittent pneumatic compression (IPC) has been acknowledged as a potential component of the multidisciplinary therapeutic strategy in the treatment of patients with breast carcinoma-associated lymphedema, prospective study of its adjunctive safety and efficacy is required. METHODS. IPC was assessed as a component of the initial therapeutic regimen for newly treated patients with breast carcinoma-associated lymphedema. Twenty-three patients who had not previously been treated for lymphedema were randomized to receive either decongestive lymphatic therapy (DLT) alone or DLT with daily adjunctive IPC. Patients with stable, treated, breast carcinoma-associated lymphedema also were assessed in the maintenance phase of therapy. Twenty-seven patients were randomized either to DLT alone or to DLT coupled with daily IPC. In both studies, objective assessment included serial measurement of volume by water displacement, tissue tonometry to assess elasticity of the skin, and goniometry to measure joint mobility. RESULTS. During initial treatment, the addition of IPC to standard DLT yielded an additional mean volume reduction (45.3% vs. 26%; P < 0.05). During maintenance DLT alone, there was a mean increase in volume (32.7 ± 115.2 mL); with DLT and IPC, there was a mean volume reduction (89.5 ± 195.5 mL; P < 0.05). In both studies, IPC was tolerated well without detectable adverse effects on skin elasticity or joint range of motion. CONCLUSIONS. When IPC is used adjunctively with other, established elements of DLT, it provides an enhancement of the therapeutic response. IPC is well tolerated and remarkably free of complications.
C02 01  X    @0 002B20E02
C03 01  X  FRE  @0 Carcinome @5 01
C03 01  X  ENG  @0 Carcinoma @5 01
C03 01  X  SPA  @0 Carcinoma @5 01
C03 02  X  FRE  @0 Glande mammaire @5 02
C03 02  X  ENG  @0 Mammary gland @5 02
C03 02  X  SPA  @0 Glándula mamaria @5 02
C03 03  X  FRE  @0 Lymphoedème @5 04
C03 03  X  ENG  @0 Lymphedema @5 04
C03 03  X  SPA  @0 Linfedema @5 04
C03 04  X  FRE  @0 Compression @5 07
C03 04  X  ENG  @0 Compression @5 07
C03 04  X  SPA  @0 Compresión @5 07
C03 05  X  FRE  @0 Système pneumatique @5 08
C03 05  X  ENG  @0 Pneumatic system @5 08
C03 05  X  SPA  @0 Sistema neumático @5 08
C03 06  X  FRE  @0 Intermittent @5 09
C03 06  X  ENG  @0 Intermittent @5 09
C03 06  X  SPA  @0 Intermitente @5 09
C03 07  X  FRE  @0 Traitement @5 10
C03 07  X  ENG  @0 Treatment @5 10
C03 07  X  SPA  @0 Tratamiento @5 10
C03 08  X  FRE  @0 Pompe @5 11
C03 08  X  ENG  @0 Pump @5 11
C03 08  X  SPA  @0 Bomba @5 11
C03 09  X  FRE  @0 Physiothérapie @5 12
C03 09  X  ENG  @0 Physiotherapy @5 12
C03 09  X  SPA  @0 Fisioterapia @5 12
C03 10  X  FRE  @0 Homme @5 13
C03 10  X  ENG  @0 Human @5 13
C03 10  X  SPA  @0 Hombre @5 13
C07 01  X  FRE  @0 Tumeur maligne @5 37
C07 01  X  ENG  @0 Malignant tumor @5 37
C07 01  X  SPA  @0 Tumor maligno @5 37
C07 02  X  FRE  @0 Glande mammaire pathologie @2 NM @5 38
C07 02  X  ENG  @0 Mammary gland diseases @2 NM @5 38
C07 02  X  SPA  @0 Glándula mamaria patología @2 NM @5 38
C07 03  X  FRE  @0 Appareil circulatoire pathologie @5 45
C07 03  X  ENG  @0 Cardiovascular disease @5 45
C07 03  X  SPA  @0 Aparato circulatorio patología @5 45
C07 04  X  FRE  @0 Lymphatique pathologie @5 46
C07 04  X  ENG  @0 Lymphatic vessel disease @5 46
C07 04  X  SPA  @0 Linfático patología @5 46
N21       @1 027
N82       @1 PSI

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Pascal:03-0050471

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<term>Lymphedema</term>
<term>Mammary gland</term>
<term>Physiotherapy</term>
<term>Pneumatic system</term>
<term>Pump</term>
<term>Treatment</term>
</keywords>
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<term>Carcinome</term>
<term>Glande mammaire</term>
<term>Lymphoedème</term>
<term>Compression</term>
<term>Système pneumatique</term>
<term>Intermittent</term>
<term>Traitement</term>
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<term>Physiothérapie</term>
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<div type="abstract" xml:lang="en">BACKGROUND. Disruption of the lymphatic circulation through breast carcinoma-associated axillary lymph node dissection, with or without radiation therapy, reportedly is the most common cause of lymphedema in developed countries. There is no cure for breast carcinoma-associated lymphedema. Although intermittent pneumatic compression (IPC) has been acknowledged as a potential component of the multidisciplinary therapeutic strategy in the treatment of patients with breast carcinoma-associated lymphedema, prospective study of its adjunctive safety and efficacy is required. METHODS. IPC was assessed as a component of the initial therapeutic regimen for newly treated patients with breast carcinoma-associated lymphedema. Twenty-three patients who had not previously been treated for lymphedema were randomized to receive either decongestive lymphatic therapy (DLT) alone or DLT with daily adjunctive IPC. Patients with stable, treated, breast carcinoma-associated lymphedema also were assessed in the maintenance phase of therapy. Twenty-seven patients were randomized either to DLT alone or to DLT coupled with daily IPC. In both studies, objective assessment included serial measurement of volume by water displacement, tissue tonometry to assess elasticity of the skin, and goniometry to measure joint mobility. RESULTS. During initial treatment, the addition of IPC to standard DLT yielded an additional mean volume reduction (45.3% vs. 26%; P < 0.05). During maintenance DLT alone, there was a mean increase in volume (32.7 ± 115.2 mL); with DLT and IPC, there was a mean volume reduction (89.5 ± 195.5 mL; P < 0.05). In both studies, IPC was tolerated well without detectable adverse effects on skin elasticity or joint range of motion. CONCLUSIONS. When IPC is used adjunctively with other, established elements of DLT, it provides an enhancement of the therapeutic response. IPC is well tolerated and remarkably free of complications.</div>
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<s0>BACKGROUND. Disruption of the lymphatic circulation through breast carcinoma-associated axillary lymph node dissection, with or without radiation therapy, reportedly is the most common cause of lymphedema in developed countries. There is no cure for breast carcinoma-associated lymphedema. Although intermittent pneumatic compression (IPC) has been acknowledged as a potential component of the multidisciplinary therapeutic strategy in the treatment of patients with breast carcinoma-associated lymphedema, prospective study of its adjunctive safety and efficacy is required. METHODS. IPC was assessed as a component of the initial therapeutic regimen for newly treated patients with breast carcinoma-associated lymphedema. Twenty-three patients who had not previously been treated for lymphedema were randomized to receive either decongestive lymphatic therapy (DLT) alone or DLT with daily adjunctive IPC. Patients with stable, treated, breast carcinoma-associated lymphedema also were assessed in the maintenance phase of therapy. Twenty-seven patients were randomized either to DLT alone or to DLT coupled with daily IPC. In both studies, objective assessment included serial measurement of volume by water displacement, tissue tonometry to assess elasticity of the skin, and goniometry to measure joint mobility. RESULTS. During initial treatment, the addition of IPC to standard DLT yielded an additional mean volume reduction (45.3% vs. 26%; P < 0.05). During maintenance DLT alone, there was a mean increase in volume (32.7 ± 115.2 mL); with DLT and IPC, there was a mean volume reduction (89.5 ± 195.5 mL; P < 0.05). In both studies, IPC was tolerated well without detectable adverse effects on skin elasticity or joint range of motion. CONCLUSIONS. When IPC is used adjunctively with other, established elements of DLT, it provides an enhancement of the therapeutic response. IPC is well tolerated and remarkably free of complications.</s0>
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<s0>Mammary gland diseases</s0>
<s2>NM</s2>
<s5>38</s5>
</fC07>
<fC07 i1="02" i2="X" l="SPA">
<s0>Glándula mamaria patología</s0>
<s2>NM</s2>
<s5>38</s5>
</fC07>
<fC07 i1="03" i2="X" l="FRE">
<s0>Appareil circulatoire pathologie</s0>
<s5>45</s5>
</fC07>
<fC07 i1="03" i2="X" l="ENG">
<s0>Cardiovascular disease</s0>
<s5>45</s5>
</fC07>
<fC07 i1="03" i2="X" l="SPA">
<s0>Aparato circulatorio patología</s0>
<s5>45</s5>
</fC07>
<fC07 i1="04" i2="X" l="FRE">
<s0>Lymphatique pathologie</s0>
<s5>46</s5>
</fC07>
<fC07 i1="04" i2="X" l="ENG">
<s0>Lymphatic vessel disease</s0>
<s5>46</s5>
</fC07>
<fC07 i1="04" i2="X" l="SPA">
<s0>Linfático patología</s0>
<s5>46</s5>
</fC07>
<fN21>
<s1>027</s1>
</fN21>
<fN82>
<s1>PSI</s1>
</fN82>
</pA>
</standard>
</inist>
</record>

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