Reduction of lymphedema using complete decongestive therapy: roles of prior radiation therapy and extent of axillary dissection.

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.