Lymphatic drainage system of the brain: A novel target for intervention of neurological diseases

Lymphoedema is an oedematous condition with a specific and complex tissue biology. In the clinical context of cancer, the pathogenesis of lymphoedema ensues most typically from the modalities employed to stage and treat the cancer (in particular, surgery and radiotherapy). Despite advances in cancer treatment, lifelong lymphoedema (limb swelling and the accompanying chronic inflammatory processes) affects approximately one in seven individuals treated for cancer, although estimates of lymphoedema prevalence following cancer treatment vary widely depending upon the diagnostic criteria used and the duration of follow-up. The natural history of cancer-associated lymphoedema is defined by increasing limb girth, fibrosis, inflammation, abnormal fat deposition and eventual marked cutaneous pathology, which also increases the risk of recurrent skin infections. Lymphoedema can substantially affect the daily quality of life of patients, as, in addition to aesthetic concerns, it can cause discomfort and affect the ability to carry out daily tasks. Clinical diagnosis is dependent on comparison of the affected region with the equivalent region on the unaffected side and, if available, with pre-surgical measurements. Surveillance is indicated in this high-risk population to facilitate disease detection at the early stages, when therapeutic interventions are most effective. Treatment modalities include conservative physical strategies that feature complex decongestive therapy (including compression garments) and intermittent pneumatic compression, as well as an emerging spectrum of surgical interventions, including liposuction for late-stage disease. The future application of pharmacological and microsurgical therapeutics for cancer-associated lymphoedema holds great promise.

Cancer-associated secondary lymphoedema.

A work group from the American Physical Therapy Association (APTA) Academy of Oncologic Physical Therapy developed a clinical practice guideline to aid clinicians in identifying interventions for people with breast cancer-related lymphedema, targeting volume reduction, beginning at breast cancer diagnosis and continuing through cancer treatments and survivorship Following a systematic review of published studies and a structured appraisal process, recommendations were developed to guide physical therapists and other health care clinicians in their intervention selection Overall, clinical practice recommendations were formulated based on the evidence for each intervention and were assigned a grade based on the strength of the evidence The evidence for each specific intervention was synthesized and appraised by lymphedema stage, when the information was available In an effort to make recommendations clinically applicable, they were presented by modality throughout the care trajectory Methodology and research populations varied significantly across studies, and it will be important for future research to use standardized definitions for participant characteristics, diagnostic criteria, and interventions

Interventions for Breast Cancer-Related Lymphedema: Clinical Practice Guideline From the Academy of Oncologic Physical Therapy of APTA.

Manual lymphatic drainage (MLD) massage is widely accepted as a conservative treatment for lymphedema. This systematic review aims to examine the methodologies used in recent research and evaluate the effectiveness of MLD for those at-risk of or living with lymphedema. The electronic databases Embase, PubMed, CINAHL Complete and Cochrane Central Register of Controlled Trials were searched using relevant terms. Studies comparing MLD with another intervention or control in patients at-risk of or with lymphedema were included. Studies were critically appraised with the PEDro scale. Seventeen studies with a total of 867 female and two male participants were included. Only studies examining breast cancer-related lymphedema were identified. Some studies reported positive effects of MLD on volume reduction, quality of life and symptom-related outcomes compared with other treatments, while other studies reported no additional benefit of MLD as a component of complex decongestive therapy. In patients at-risk, MLD was reported to reduce incidence of lymphedema in some studies, while others reported no such benefits. The reviewed articles reported conflicting findings and were often limited by methodological issues. This review highlights the need for further experimental studies on the effectiveness of MLD in lymphedema. There is some evidence that MLD in early stages following breast cancer surgery may help prevent progression to clinical lymphedema. MLD may also provide additional benefits in volume reduction for mild lymphedema. However, in moderate to severe lymphedema, MLD may not provide additional benefit when combined with complex decongestive therapy.

Manual lymphatic drainage treatment for lymphedema: a systematic review of the literature

Objectives Breast cancer-related lymphedema (BCRL) represents a major complication of breast cancer treatment, impacting the quality of life for breast cancer survivors that develop it. The purpose of this review is to evaluate the literature surrounding BCRL treatment modalities to guide clinicians regarding risk-stratified treatment options. Methods A review of studies over a 10-year period (January 2006 to February 2016) was performed. Noninvasive strategies evaluated included compression therapy, manual lymphatic drainage, and complex decongestive therapy (CDT). Invasive modalities evaluated included liposuction and lymphatic bypass/lymph node transfer (LNT). Our search yielded 149 initial results with 45 studies included. Results A number of prospective studies have found that CDT is associated with volume reduction in the affected limb as well as improved quality of life, particularly in patients with early stage BCRL. With regards to invasive treatment options, data support that lymphatic bypass and LNT are associated with symptomatic and physiologic improvements, particularly in patients with more advanced BCRL. In addition, a small number of studies suggest that liposuction may be an efficacious and safe treatment for moderate to severe BCRL. Conclusions CDT is an effective treatment modality for early stage BCRL. For more advanced BCRL, LNT has demonstrated efficacy. Further study is required with respect to comparing BCRL treatment modalities.

A Review of Treatment for Breast Cancer-Related Lymphedema: Paradigms for Clinical Practice.

Complex Decongestive Lymphatic Therapy With or Without Vodder II Manual Lymph Drainage in More Severe Chronic Postmastectomy Upper Limb Lymphedema: A Randomized Noninferiority Prospective Study

studies. Regarding the clinical forms of LP, the exclusive oral-compromising form prevailed among the seropositive HCV group (30%) as compared to the seronegative HCV group (6.38%). The erosive form was the most common, in agreement with some studies. Association between HBV, HIV, and LP has never been demonstrated. In conclusion, a higher percentage of positive HCV serology emerged in LP patients in the Brazilian population. Positive HCV serology appeared mainly in patients with oral lesions, as indicated by serological screening for HCV at the time of LP diagnosis. It is important to draw the attention of the clinical staff to the fact that no anti-HCV serology was requested for 30/134 (22.4%) patients with LP.

The application of negative pressure wound therapy combined with compression bandaging for the decubitus ulcer of an advanced primary lower limb lymphedema.

Medical care for patients with oedema in the Polish health care system is fragmented and rarely ensures continuity of therapy. During the COVID-19 pandemic, the availability of traditional forms is even more difficult, which forces the search for alternative, remote forms enabling early diagnosis and implementation of proper management. Thus article presents a model of management in patients at risk of developing edema and with advanced disease in the pandemic days in the light of the current recommendations. In the lymphedema clinic, a method of questionnaire preliminary qualification of patients reported by phone or e–mail which facilitates distinguishing urgent cases (swelling that is advanced, rapidly increasing, especially despite compression therapy, complicated by skin damage, occurring in children < 12 years old or associated with advanced cancer) was introduced. Between June 2020 and March 2021, 160 patients usually needing the adjustment of another compression garment continued the therapy, and 94 persons required complex decongestive therapy and then prescribing of compression product to be worn during a day were admitted for the first time. A narrative review of the literature between 2011–2021 including prophylactic recommendations and conservative management of edema in terms of its realistic applicability under the existing restrictions, was carried out. Despite the limitations in the implementation of physiotherapy, the availability of therapy based on education and compression therapy in connection with individually selected, aerobic exercise was maintained in the clinic.

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Lymphoedema management during the COVID-19 pandemic

Physical therapy with good compliance remains the key of success in lymphedema management. Tissue excisions should be reserved for physiotherapy-resistant cases and always followed by extended maintenance compression therapy. We present the case of the successful physical therapy of the young female with a neglected, massive, primary lymphedema of the lower extremity present since birth, with prior extensive tissue resection. Complex decongestive physical therapy has been performed for one year, combined with ten months’ of negative-pressure wound therapy at a hospice facility due to pressure ulcers complication. Obtained reduction of the affected extremity/edema volumes (by 69.4 and 88.2% respectively) enhanced patient’s mobility, helping her become more independent. Ongoing therapeutical program maintained these results for three years. Physical therapy even in far-advanced and neglected cases may be effective. Lymphedema services should be offered widely through a network of fully reimbursed health care system, delivering high-quality evidence-based management tailored to individual patients.

/pdf/physical-therapy-of-far-advanced-primary-lower-limb-5cq96w3f35.pdf

Joanna Kurpiewska

Papers

Complex Decongestive Lymphatic Therapy With or Without Vodder II Manual Lymph Drainage in More Severe Chronic Postmastectomy Upper Limb Lymphedema: A Randomized Noninferiority Prospective Study

The application of negative pressure wound therapy combined with compression bandaging for the decubitus ulcer of an advanced primary lower limb lymphedema.

Lymphoedema management during the COVID-19 pandemic

Physical therapy of far-advanced primary lower limb lymphedema: a case report and literature review