Baxter G David, Liu Lizhou, Petrich Simone, Gisselman Angela Spontelli, Chapple Cathy, Anders Juanita J, Tumilty Steve
Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
Department of Surgical Sciences, Southern District Health Board, Dunedin, New Zealand.
BMC Cancer. 2017 Dec 7;17(1):833. doi: 10.1186/s12885-017-3852-x.
Breast cancer related lymphedema (BCRL) is a prevalent complication secondary to cancer treatments which significantly impacts the physical and psychological health of breast cancer survivors. Previous research shows increasing use of low level laser therapy (LLLT), now commonly referred to as photobiomodulation (PBM) therapy, for BCRL. This systematic review evaluated the effectiveness of LLLT (PBM) in the management of BCRL.
Clinical trials were searched in PubMed, AMED, Web of Science, and China National Knowledge Infrastructure up to November 2016. Two reviewers independently assessed the methodological quality and adequacy of LLLT (PBM) in these clinical trials. Primary outcome measures were limb circumference/volume, and secondary outcomes included pain intensity and range of motion. Because data were clinically heterogeneous, best evidence synthesis was performed.
Eleven clinical trials were identified, of which seven randomized controlled trials (RCTs) were chosen for analysis. Overall, the methodological quality of included RCTs was high, whereas the reporting of treatment parameters was poor. Results indicated that there is strong evidence (three high quality trials) showing LLLT (PBM) was more effective than sham treatment for limb circumference/volume reduction at a short-term follow-up. There is moderate evidence (one high quality trial) indicating that LLLT (PBM) was more effective than sham laser for short-term pain relief, and limited evidence (one low quality trial) that LLLT (PBM) was more effective than no treatment for decreasing limb swelling at short-term follow-up.
Based upon the current systematic review, LLLT (PBM) may be considered an effective treatment approach for women with BCRL. Due to the limited numbers of published trials available, there is a clear need for well-designed high-quality trials in this area. The optimal treatment parameters for clinical application have yet to be elucidated.
乳腺癌相关淋巴水肿（BCRL）是癌症治疗后的一种常见并发症，严重影响乳腺癌幸存者的身心健康。先前的研究表明，低强度激光疗法（LLLT），现通常称为光生物调节（PBM）疗法，在BCRL治疗中的应用越来越多。本系统评价评估了LLLT（PBM）在BCRL治疗中的有效性。
检索截至2016年11月的PubMed、AME D、科学网和中国知网中的临床试验。两名评价者独立评估这些临床试验中LLLT（PBM）的方法学质量和充分性。主要结局指标为肢体周长/体积，次要结局包括疼痛强度和活动范围。由于数据在临床上存在异质性，因此进行了最佳证据综合分析。
共识别出11项临床试验，其中7项随机对照试验（RCT）被选入分析。总体而言，纳入的RCT的方法学质量较高，而治疗参数的报告较差。结果表明，有强有力的证据（三项高质量试验）表明，在短期随访中，LLLT（PBM）在减少肢体周长/体积方面比假治疗更有效。有中等证据（一项高质量试验）表明，LLLT（PBM）在短期疼痛缓解方面比假激光更有效，有限的证据（一项低质量试验）表明，在短期随访中，LLLT（PBM）在减轻肢体肿胀方面比不治疗更有效。
基于当前的系统评价，LLLT（PBM）可被视为治疗BCRL女性的一种有效治疗方法。由于可用的已发表试验数量有限，该领域显然需要设计良好的高质量试验。临床应用的最佳治疗参数尚待阐明。
