Pinell Ximena A, Kirkpatrick Stephanie H, Hawkins Kennedy, Mondry Tammy E, Johnstone Peter A S
Radiation Oncology Department, Emory University School of Medicine, Atlanta, Georgia, USA.
Cancer. 2008 Feb 15;112(4):950-4. doi: 10.1002/cncr.23242.
Complete decongestive therapy (CDT), including manual lymphatic drainage (MLD) is a manipulative intervention of documented benefit to patients with lymphedema (LE). Although the role of CDT for LE is well described, to the authors' knowledge there are no data regarding its efficacy for patients with LE due to tumor masses in the draining anatomic bed. Traditionally, LE therapists are wary of providing therapy to such patients with 'malignant' LE for fear of exacerbating the underlying cancer, and that the obstruction will render therapy less effective. In the current study, the authors' experience providing CDT for such patients is discussed.
Cancer survivors with LE were referred to therapists at 2 Atlanta-area clinics. CDT consists of treatment (Phase 1) and maintenance phases (Phase 2). During Phase 1, the patient undergoes manipulative therapy and bandaging daily until the LE reduction plateaus; at that point, Phase 2 (self-care) begins. At the beginning and end of Phase 1, LE is quantified and differences in girth volume calculated. The results for patients completing Phase 1 therapy for LE in the presence of locoregional masses were compared with results for patients with LE in the absence of such disease. Both volume reduction of the affected limb and number of treatments to plateau were analyzed.
Between January 2004, and March 2007, LE of 82 limbs in 72 patients was treated with CDT and Phase 1 was completed. The median number of treatments to plateau was 12 (range, 4-23 treatments); the median limb volume reduction was 22% (range, -23 to 164%). Nineteen limbs (16 patients) with associated chest wall/axillary or pelvic/inguinal tumors had nonsignificant difference in LE reduction (P = .75) in the presence of significantly more sessions to attain plateau (P = .0016) compared with 63 limbs in 56 patients without such masses.
Patients with LE may obtain relief with CDT regardless of whether they have locoregional disease contributing to their symptoms. However, it will likely take longer to achieve that effect. Manipulative therapy of LE should not be withheld because of persistent or recurrent disease in the draining anatomic bed.
完全减压疗法（CDT），包括手法淋巴引流（MLD），是一种已被证明对淋巴水肿（LE）患者有益的手法干预。尽管CDT对LE的作用已有充分描述，但据作者所知，尚无关于其对引流解剖部位存在肿瘤肿块的LE患者疗效的数据。传统上，LE治疗师对为这类患有“恶性”LE的患者提供治疗持谨慎态度，因为担心会加重潜在癌症，并且认为阻塞会使治疗效果降低。在本研究中，讨论了作者为这类患者提供CDT的经验。
患有LE的癌症幸存者被转介到亚特兰大地区的两家诊所接受治疗。CDT包括治疗阶段（第1阶段）和维持阶段（第2阶段）。在第1阶段，患者每天接受手法治疗和包扎，直到LE减轻达到平台期；此时，第2阶段（自我护理）开始。在第1阶段开始和结束时，对LE进行量化，并计算周长体积的差异。将在存在局部肿块的情况下完成LE第1阶段治疗的患者结果与不存在此类疾病的LE患者结果进行比较。分析了患侧肢体的体积减少情况以及达到平台期所需的治疗次数。
在2004年1月至2007年3月期间，72例患者的82条肢体的LE接受了CDT治疗并完成了第1阶段。达到平台期的治疗次数中位数为12次（范围为4 - 23次治疗）；肢体体积减少的中位数为22%（范围为 - 23%至164%）。与56例无此类肿块患者的63条肢体相比，19条肢体（16例患者）伴有胸壁/腋窝或盆腔/腹股沟肿瘤，在达到平台期所需治疗次数显著更多（P = 0.0016）的情况下，LE减轻无显著差异（P = 0.75）。
患有LE的患者无论是否存在导致其症状的局部疾病，都可能通过CDT获得缓解。然而，可能需要更长时间才能达到这种效果。不应因引流解剖部位存在持续性或复发性疾病而停止对LE的手法治疗。
