The Ohio State University, Columbus, OH 43201, USA.
J Clin Oncol. 2012 Oct 20;30(30):3726-33. doi: 10.1200/JCO.2012.41.8574. Epub 2012 Sep 24.
PURPOSE Cancer-related lymphedema (LE) is an incurable condition associated with lymph-involved cancer treatments and is an increasing health, quality of life (QOL), and cost burden on a growing cancer survivor population. This review examines the evidence for causes, risk, prevention, diagnosis, treatment, and impact of this largely unexamined survivorship concern. METHODS PubMed and Medline were searched for cancer-related LE literature published since 1990 in English. The resulting references (N = 726) were evaluated for strength of design, methods, sample size, and recent publication and sorted into categories (ie, causes/prevention, diagnosis, treatment, and QOL). Sixty studies were included. Results Exercise and physical activity and sentinel lymph node biopsy reduce risk, and overweight and obesity increase risk. Evidence that physiotherapy reduces risk and that lymph node status and number of malignant nodes increase risk is less strong. Perometry and bioimpedence emerged as attractive diagnostic technologies, replacing the use of water displacement in clinical practice. Swelling can also be assessed by measuring arm circumference and relying on self-report. Symptoms can be managed, not cured, with complex physical therapy, low-level laser therapy, pharmacotherapy, and surgery. Sequelae of LE negatively affect physical and mental QOL and range in severity. However, the majority of reviewed studies involved patients with breast cancer; therefore, results may not be applicable to all cancers. CONCLUSION Research into causes, prevention, and effect on QOL of LE and information on LE in cancers other than breast is needed. Consensus on definitions and measurement, increased patient and provider awareness of signs and symptoms, and proper and prompt treatment/access, including psychosocial support, are needed to better understand, prevent, and treat LE.
目的 癌症相关淋巴水肿（LE）是一种与淋巴相关的癌症治疗相关的不可治愈的疾病，它给不断增长的癌症幸存者群体带来了健康、生活质量（QOL）和成本负担方面的问题。本综述探讨了这种在很大程度上未被研究的生存问题的病因、风险、预防、诊断、治疗和影响的证据。
方法 检索自 1990 年以来以英文发表的与癌症相关的 LE 文献，使用 PubMed 和 Medline。对参考资料（N = 726）的设计、方法、样本量和最近的出版物进行评估，并将其分为几类（即病因/预防、诊断、治疗和 QOL）。共纳入 60 项研究。
结果 运动和体育活动以及前哨淋巴结活检可以降低风险，超重和肥胖会增加风险。有证据表明物理疗法可以降低风险，而淋巴结状况和恶性淋巴结数量增加的风险则不太明确。人体体积描记法和生物电阻抗法作为有吸引力的诊断技术出现，取代了临床实践中使用的水置换法。也可以通过测量臂围并依靠自我报告来评估肿胀。可以通过复杂的物理治疗、低水平激光治疗、药物治疗和手术来管理症状，而不是治愈。LE 的后遗症会对身体和心理健康 QOL 产生负面影响，严重程度不一。然而，大多数被审查的研究都涉及乳腺癌患者；因此，结果可能不适用于所有癌症。
结论 需要研究 LE 的病因、预防和对 QOL 的影响，以及除乳腺癌以外的癌症中 LE 的信息。需要就定义和测量达成共识，提高患者和提供者对体征和症状的认识，以及进行适当和及时的治疗/获得治疗的机会，包括社会心理支持，以更好地了解、预防和治疗 LE。
