Thomas R Croft, Hawkins Kennedy, Kirkpatrick Stephanie H, Mondry Tammy E, Gabram-Mendola Sheryl, Johnstone Peter A S
Radiation Oncology Department, Emory Universiy School of Medicine, Atlanta, GA 30322, USA.
J Soc Integr Oncol. 2007 Summer;5(3):87-91. doi: 10.2310/7200.2007.004.
Although radiation therapy (RT) contributes to lymphedema (LE), it is unknown whether RT contributes to more difficulty (more treatments) or less success (decreased LE reduction) with therapy for established LE. We reviewed the results of complete decongestive therapy (CDT) for LE with respect to a history of RT and the number of lymph nodes dissected. Breast cancer survivors with LE were referred to CDT-certified therapists. CDT consists of treatment (phase 1) and maintenance (phase 2) phases. During phase 1, the patient meets with a therapist daily until the LE reduction plateaus; then phase 2 (self-care) begins. During phase 1, LE is quantified weekly at a minimum. Fifty-three patients underwent CDT and completed phase 1. The median number of treatments to plateau was 12 (range 6-25); the median limb volume reduction was 36% (-4-119%). Thirty-six patients with an RT history had an insignificant difference in LE reduction (p = .49) and the number of sessions to plateau (p = .54) compared with 17 patients without RT. The median examined number of nodes was 12 (range 3-28). No significant correlation was observed between the number of nodes examined and percent reduction (r = -.390); no significant correlation (r = .291; critical r = .396 for p = .05 for both cases) was observed between the number of nodes sampled and the number of sessions to plateau. Patients with LE obtained relief regardless of whether they received surgery or surgery plus RT. The insignificant correlation between the number of lymph nodes and percent reduction could become significant with a larger sample size.
尽管放射治疗（RT）会导致淋巴水肿（LE），但对于已确诊的LE，RT是否会使治疗难度增加（更多治疗次数）或成功率降低（LE减轻程度降低）尚不清楚。我们回顾了针对有RT史和淋巴结清扫数量的LE患者进行的完全减压疗法（CDT）的结果。患有LE的乳腺癌幸存者被转介给获得CDT认证的治疗师。CDT包括治疗（第1阶段）和维持（第2阶段）阶段。在第1阶段，患者每天与治疗师会面，直到LE减轻程度趋于平稳；然后开始第2阶段（自我护理）。在第1阶段，至少每周对LE进行一次量化。53例患者接受了CDT并完成了第1阶段。达到平稳状态的治疗次数中位数为12次（范围6 - 25次）；肢体体积减轻的中位数为36%（-4% - 119%）。与17例无RT史的患者相比，36例有RT史的患者在LE减轻程度（p = 0.49）和达到平稳状态的治疗次数（p = 0.54）方面无显著差异。检查的淋巴结数量中位数为12个（范围3 - 28个）。检查的淋巴结数量与减轻百分比之间未观察到显著相关性（r = -0.390）；采样的淋巴结数量与达到平稳状态的治疗次数之间也未观察到显著相关性（r = 0.291；两种情况的临界r值为0.396，p = 0.05）。患有LE的患者无论接受手术还是手术加RT都能得到缓解。淋巴结数量与减轻百分比之间不显著的相关性在样本量更大时可能会变得显著。
