OBJECTIVE: To summarize the progress of the roles and mechanisms of various types of stem cell-based treatments and their combination therapies in both animal studies and clinical trials of lymphedema. METHODS: The literature on stem cell-based treatments for lymphedema in recent years at home and abroad was extensively reviewed, and the animal studies and clinical trials on different types of stem cells for lymphedema were summarized. RESULTS: Various types of stem cells have shown certain effects in animal studies and clinical trials on the treatment of lymphedema, mainly through local differentiation into lymphoid endothelial cells and paracrine cytokines with different functions. Current research focuses on two cell types, adipose derived stem cells and bone marrow mesenchymal stem cells, both of which have their own advantages and disadvantages, mainly reflected in the therapeutic effect of stem cells, the difficulty of obtaining stem cells and the content in vivo. In addition, stem cells can also play a synergistic role in combination with other treatments, such as conservative treatment, surgical intervention, cytokines, biological scaffolds, and so on. However, it is still limited to the basic research stage, and only a small number of studies have completed clinical trials. CONCLUSION Stem cells have great transformation potential in the treatment of lymphedema, but there is no unified standard in the selection of cell types, the amount of transplanted cells, and the timing of transplantation.
Animals ; Endothelial Cells ; Lymphedema/therapy* ; Stem Cell Transplantation ; Cytokines

Acupuncture Therapy ; Adult ; Female ; Foot Diseases ; complications ; microbiology ; Humans ; Lymphedema ; etiology ; therapy ; Mycoses ; complications ; microbiology

OBJECTIVE: To observe the clinical efficacy of lidong needling therapy (acupuncture technique combined with therapeutic movement of the body) on upper limb lymphedema after breast cancer surgery in combination with functional exercise. METHODS: A total of 73 patients with postoperative lymphedema of breast cancer in the upper limbs were randomized into an observation group (36 cases) and a control group (37 cases). The routine nursing care and functional exercise were given in the control group, twice a day, for about 10-15 min each time, lasting 8 weeks. On the basis of the treatment as the control group, lidong needling therapy was applied to the acupionts on the affected upper limb, i.e. Jianyu (LI 15), Waiguan (TE 5), Hegu (LI 4) and ashi points (the most obvious swelling sites), as well as to bilateral Yinlingquan (SP 9) and Zusanli (ST 36), etc. The needles were retained for 30 min. While the needles retained, the patients were asked to move the affected shoulder to 90° by the sagittal anteflexion and keep it elevated. Simultaneously, the hand on the affected side was clenched and opened slowly and coordinately. Lidong needling therapy was delivered once every two days, three times weekly for 8 weeks. Before and after treatment, the difference of the circumference between the affected and healthy limbs, the score of visual analogue scale (VAS) for swelling and the score of disability of arm, shoulder and hand (DASH) were compared in the patients of the two groups. The clinical efficacy was evaluated. RESULTS: After 2, 4, 6 and 8 weeks of treatment, except for the circumference of the area 10 cm below the cubitel crease in the control group, the differences in the circumferences of the rest parts between the affected and healthy limbs were reduced in comparison with those before treatment in the two groups (P<0.01, P<0.05). After 6 weeks of treatment, in the observation group, for the circumference at the level of hand between the thumb and the index finger and that of the wrist, the differences between the affected and healthy limbs was smaller compared with those in the control group (P<0.05). After 8 weeks of treatment, except for the areas 5 cm below and above the cubitel crease, the differences of circumferences between the affected and healthy limbs in the observation group were smaller than those in the control group in the rest parts (P<0.01, P<0.05). After 8 weeks of treatment, the swelling VAS scores were reduced when compared with those before treatment in the two groups (P<0.05), and the score in the observation group was lower than that in the control group (P<0.01). After 4 and 8 weeks of treatment, DASH scores were reduced in comparison with those before treatment in the two groups (P<0.01). The total effective rate of the observation group was 83.3% (30/36), which was higher than that of the control group (35.1%, 13/37, P<0.01). CONCLUSION Lidong needling therapy combined with the functional exercise obtains the satisfactory clinical effect on the upper limb lymphedema after breast cancer surgery. This treatment effectively relieves swelling and improves the upper limb function.
Humans ; Female ; Breast Neoplasms/surgery* ; Acupuncture Points ; Acupuncture Therapy/methods* ; Upper Extremity ; Treatment Outcome ; Lymphedema/therapy*

Two patients with stage three secondary lymphedema of the upper extremities underwent treatment for breast cancer, including surgery, chemotherapy, and radiotherapy. They were examined with computed tomography (CT) before and after extracorporeal shock wave therapy (ESWT). We used a manual tracing method using PiViewSTAR software to calculate the volume of the upper extremities. There was a decrease in the volume of the subcutaneous compartment measured by CT before and after ESWT. CT may be helpful in determining the treatment target area of ESWT and to monitor the effect of treatment by measuring the changes in volume before and after ESWT in patients with lymphedema. Therefore, CT may have good clinical potential for treatment and follow-up in the management of lymphedema.
Breast Neoplasms ; Drug Therapy ; High-Energy Shock Waves ; Humans ; Lymphedema* ; Radiotherapy ; Shock* ; Subcutaneous Tissue ; Upper Extremity

Radiation ulcers are wounds caused by acute or chronic effects of ionizing radiation. The injury may involve the skin, underlying soft tissue, and even deeper into bones. Radiation is used alone or in combination with surgery and chemotherapy. Although it is useful to affect tumor death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. This impairment leads to fibrosis, nonhealing ulcers, lymphedema and radionecrosis amongst others.
Drug Therapy ; Fibrosis ; Lymphedema ; Radiation, Ionizing ; Radiotherapy ; Skin ; Ulcer* ; Wound Healing ; Wounds and Injuries*

OBJECTIVE: To investigate the long-term effects of complex decongestive therapy (CDT) on edema reduction in breast cancer-related lymphedema patients after axillary dissection, according to the initial volume of edema. METHODS: A retrospective review of 57 patients with unilateral arm after an axillary dissection for breast cancer was performed. The patients, treated with two weeks of CDT and self-administered home therapy, were followed for 24 months. Arm volume was serially measured by using an optoelectronic volumeter prior to and immediately after CDT; and there were follow-up visits at 3, 6, 12, and 24 months. Patients were divided into two groups according to the percent excess volume (PEV) prior to CDT: group 1, PEV<20% and group 2, PEV> or =20%. RESULTS: In group 1, mean PEV before CDT was 11.4+/-5.0% and 14.1+/-10.6% at 24 months after CDT with no significant difference. At the end of CDT, PEV was 28.8+/-15.7% in group 2, which was significantly lower than the baseline (41.9+/-19.6%). The reduction of PEV was maintained for 24 months in group 2. CONCLUSION: The long-term effects of CDT were well-maintained for 24 months, but there was a difference in progression of PEV between the two groups. The patients with more initial PEV showed significant volume-reducing effects of CDT. In patients with less initial PEV, the severity of lymphedema did not progress to higher grades.
Arm* ; Breast Neoplasms* ; Breast* ; Edema ; Follow-Up Studies ; Humans ; Lymphedema* ; Physical Therapy Modalities ; Retrospective Studies

OBJECTIVE: To support the establishment of lymphedema education plans and the actual practice of education by investigating the current lymphedema awareness status of Korean breast cancer patients. METHODS: cross-sectional population survey was conducted in 116 breast cancer patients in the Busan-Gyeongnam area. The survey included questions regarding demographic characteristics, breast cancer-related lymphedema (BCRL) risk factors, and characteristics and treatments of the disease. Some of the items were scored to determine the level of awareness. The items that affect the awareness of lymphedema were investigated by statistical analysis. RESULTS: Eighty-one of the 116 patients answered that they had heard of lymphedema, and 30 of them (25.86%) had received explanations about the possibility of lymphedema before surgery. Only 20 patients (17.25%) knew that lymphedema is not a completely curable disease, 24 patients (20.68%) thought that lymphedema does not require any treatment, and only 56 patients (48.27%) knew that lymphedema is treated in the Department of Rehabilitation Medicine. The main factors that affected patients' awareness of lymphedema were their age, chemotherapy, duration of breast cancer, and lymphedema treatment history. CONCLUSION: The majority of survey participants who were breast cancer patients either lacked awareness of BCRL or had false ideas about it, indicating the inadequate level of education provided for lymphedema. In the case of breast cancer diagnosis, early and continuous education for future management is essential, and the framework for the provision of education including education protocols related to age, disease duration, and lymphedema treatment is needed.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Early Diagnosis ; Education ; Humans ; Korea* ; Lymphedema* ; Rehabilitation ; Risk Factors

PURPOSE: The purpose of this study was to determine the effect of EPMLM(educational program of manual lymph massage) on the arm functioning and QOL(quality of life) in breast cancer patients with lymphedema. METHOD: Subjects in the experimental group(n=20) participated in EPMLM for 6 weeks from June to July, 2005. The EPMLM consisted of training of lymph massage for 2 weeks and encourage and support of self-care using lymph massage for 4 weeks. The arm functioning assessed at pre-treatment, 2weeks, and 6weeks using Arm functioning questionnaire. The QOL assessed at pre-treatment and 6 weeks using SF-36. The outcome data of experimental group was compared with control group(n=20). The collected data was analyzed by using SPSS 10.0 statistical program. RESULT: The arm functioning of experimental group was increased from 2 weeks after(W=.224, p=.011) and statistically differenced with control group at 2 weeks(Z=-2.241, p=.024) and 6 weeks(Z=-2.453, p=.013). Physical function of QOL domain increased in experimental group(Z=-1.162, p=.050), also statistically differenced with control group(Z=-2.182, p= .030) at 6weeks. CONCLUSION: The results suggest that the educational program of manual lymph massage can improve arm functioning and physical function of QOL domain in breast cancer patients with lymphedema.
*Self Care ; *Quality of Life ; Movement ; Middle Aged ; *Massage ; Lymphedema/etiology/*therapy ; Humans ; Female ; Breast Neoplasms/*complications/therapy ; *Arm/physiopathology ; Adult

OBJECTIVE: To observe the clinical efficacy of transcutaneous electrical acupoint stimulation (TEAS) combined with warm acupuncture in treating breast cancer associated with upper limb lymphedema (BCRL). METHODS: This was a retrospective cohort study using a paired control design. Fifty-two BCRL patients were assigned to the control group (27 cases) and the treatment group (25 cases). The patients in the control group were treated with lymphedema comprehensive detumescence treatment (CDT) for 4 weeks, including systematic therapy composed of manual lymphatic drainage, compression bandage, skincare, and functional exercise. The patients in the treatment group were treated with TEAS combined with warm acupuncture based on the control group methods. Each treatment lasted for 30 min and was applied twice a week for 4 weeks. The arm circumference (AC) of different positions of the affected limb and the degree of swelling of the affected limb were evaluated before the first treatment and after the last treatment. The clinical efficacy was evaluated according to the degree of edema before and after treatment. All adverse events during treatment were recorded. RESULTS: The patients' AC and the swelling feeling of the affected limb in the treatment group and the control group were both reduced compared with those before treatment. Compared with the control group, AC of the wrist joint transverse stria, the midpoint between the wrist joint transverse stria and the elbow joint transverse stria in the treatment group were significantly reduced (P<0.05). The decrease in AC diameter at the midpoint between the elbow joint transverse stria and the axillary transverse stria was the most significant (P<0.01). The swelling degree of the affected limbs in the treatment group was significantly lower than before treatment, and was significantly lower compared with the control group after treatment (P<0.01). The total effective rate was 72% in the treatment group, significantly higher than that in the control group (55.56%, P<0.05). No serious adverse events occured in either group. CONCLUSIONS TEAS combined with warm acupuncture can effectively reduce AC and swelling feeling of the affected limb in patients with BCRL. The effect is better than that of CDT therapy alone. (Registration No. ChiCTR2200062075).
Humans ; Female ; Breast Neoplasms/therapy* ; Acupuncture Points ; Retrospective Studies ; Lymphedema/complications* ; Acupuncture Therapy/adverse effects* ; Upper Extremity ; Treatment Outcome

PURPOSE: We wanted to evaluate the risk factors for developing lymphedema following axillary lymph node dissection in breast cancer patients. METHODS: Ninety-six patients who underwent axillary dissection for breast cancer were followed-up for up to 1 year. Lymphedema was assessed using a serial circumferential measurement method. More than a 2 cm difference in circumference was considered as clinically significant lymphedema. The effects of age, the body mass index (BMI), the cancer stage, chemotherapy, radiotherapy, the location of cancer and creating a latissimus dorsi (LD) flap on the development of lymphedema were analyzed. RESULTS: The incidence of lymphedema was increased with the advancing cancer stage. Radiotherapy was found to increase the incidence of lymphedema. Patients who had received an LD flap showed a lower incidence of lymphedema. CONCLUSION: These results could be useful as a clinical guideline for creating a management plan for postoperative lymphedema. Because there are some differences in the results between all the relevant reports, including ours, further research is needed in the form of a large, multi-center, long-term study.
Body Mass Index ; Breast Neoplasms* ; Breast* ; Drug Therapy ; Humans ; Incidence ; Lymph Node Excision ; Lymphedema* ; Radiotherapy ; Risk Factors* ; Superficial Back Muscles