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BreastOriginal Article
Abstract
BACKGROUND: Lymphedema following breast cancer treatment is one of the most morbid conditions affecting breast
cancer survivors. Currently, no therapy completely cures this condition. Comprehensive Decongestive Therapy (CDT),
a novel physiotherapeutic method offers promising results in managing this condition. This therapy is being widely
used in the West. Till date, there are no studies evaluating the effectiveness and feasibility of this therapy in the east.
MATERIALS AND METHODS: The therapeutic responses of 25 patients with postmastectomy lymphedema were analyzed
prospectively in this study. Each patient received an intensive phase of therapy for eight days from trained physiotherapists,
which included manual lymphatic drainage, multi layered compression bandaging, exercises, and skin care. Instruction in
self management techniques were given to the patients on completion of intensive therapy. The patients were followed up
for three months. Changes in the volume of the edematous limb were assessed with a geometric approximation derived
from serial circumference measurements of the limb and by water displacement volumetry. Changes in skin and sub cutis
thickness were assessed using high frequency ultrasound. RESULTS: The reduction in limb volume observed after therapy
was 32.3% and 42% of the excess, by measurement and volumetry, respectively. The maximum reduction was obtained
after the intensive phase. The reduction in skin and subcutis thickness of the edematous limb followed the same pattern as
volume reduction. Patients could maintain the reduction obtained by strictly following the protocols of the maintenance phase.
CONCLUSIONS: CDT combined with long-term self management is effective in treating post mastectomy lymphedema.
The tropical climate is a major factor limiting the regular use of bandages by the patients.
Key words: Comprehensive decongestive therapy, manual lymphatic drainage, volumetry
Introduction
Postmastectomy lymphedema is one of the most morbid
conditions occurring after breast cancer therapy, causing
severe physical, functional, and psychological distress to
the patient. With improvements in breast cancer therapy,
more women become long time survivors and hence
the long term postoperative complications and their
management become an increasingly important issue.[1]
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DOI:
10.4103/0019-509X.92250
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Randheer, et al.: CDT in postmastectomy lymphedema
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Randheer, et al.: CDT in postmastectomy lymphedema
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Randheer, et al.: CDT in postmastectomy lymphedema
Discussion
Table 2: Absolute limb volume reduction obtained following CDT- for edematous limb
Time period
Mean reduction
(ml)- By measurement
Mean Reduction
(ml)-By volumetry
P value
209
-20.3
25.9
10.1
224.7
394.4
-0.01
72.5
18.1
485
<0.001
>0.05
>0.05
>0.05
<0.001
Mean reduction
(mm) at Mid forearm
0.92
-0.1
0.2
0.2
1
P value
Mean reduction
(mm) at Mid arm
0.7
-0.1
0.13
0.028
0.7
<0.001
>0.05
>0.05
>0.05
<0.001
Mean reduction
(mm) at Mid forearm
P value
1.8
2.25
0.18
0.4
0.18
2.5
-0.14
0.6
0.25
3
<0.005(arm)
<0.01(forearm)
>0.05
>0.05
>0.05
<0.01(arm)
<0.001(forearm)
Time period
400
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Randheer, et al.: CDT in postmastectomy lymphedema
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Randheer, et al.: CDT in postmastectomy lymphedema
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