Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA.
Breast Cancer Res Treat. 2018 Jul;170(1):77-87. doi: 10.1007/s10549-018-4743-9. Epub 2018 Mar 8.
Approximately 20% of breast cancer survivors develop breast cancer-related lymphedema (BCRL), and current therapies are limited. We compared acupuncture (AC) to usual care wait-list control (WL) for treatment of persistent BCRL.
Women with moderate BCRL lasting greater than six months were randomized to AC or WL. AC included twice weekly manual acupuncture over six weeks. We evaluated the difference in circumference and bioimpedance between affected and unaffected arms. Responders were defined as having a decrease in arm circumference difference greater than 30% from baseline. We used analysis of covariance for circumference and bioimpedance measurements and Fisher's exact to determine the proportion of responders.
Among 82 patients, 73 (89%) were evaluable for the primary endpoint (36 in AC, 37 in WL). 79 (96%) patients received lymphedema treatment before enrolling in our study; 67 (82%) underwent ongoing treatment during the trial. We found no significant difference between groups for arm circumference difference (0.38 cm greater reduction in AC vs. WL, 95% CI - 0.12 to 0.89, p = 0.14) or bioimpedance difference (1.06 greater reduction in AC vs. WL, 95% CI - 5.72 to 7.85, p = 0.8). There was also no difference in the proportion of responders: 17% AC versus 11% WL (6% difference, 95% CI - 10 to 22%, p = 0.5). No severe adverse events were reported.
Our acupuncture protocol appeared to be safe and well tolerated. However, it did not significantly reduce BCRL in pretreated patients receiving concurrent lymphedema treatment. This regimen does not improve upon conventional lymphedema treatment for breast cancer survivors with persistent BCRL.
大约 20%的乳腺癌幸存者会发展为乳腺癌相关淋巴水肿（BCRL），目前的治疗方法有限。我们比较了针灸（AC）与常规护理等待名单对照（WL）治疗持续性 BCRL 的效果。
患有持续时间超过 6 个月的中度 BCRL 的女性被随机分配到 AC 或 WL 组。AC 包括 6 周内每周两次的手动针刺。我们评估了患病臂和未患病臂的周长和生物阻抗之间的差异。应答者定义为臂围差较基线减少大于 30%。我们使用协方差分析周长和生物阻抗测量值，并使用 Fisher 精确检验确定应答者的比例。
在 82 名患者中，73 名（89%）可评估主要终点（AC 组 36 名，WL 组 37 名）。79 名（96%）患者在参加我们的研究前接受过淋巴水肿治疗；67 名（82%）在试验期间接受了持续治疗。我们未发现两组间臂围差（AC 组较 WL 组减少 0.38cm，95%CI -0.12 至 0.89，p=0.14）或生物阻抗差（AC 组较 WL 组减少 1.06，95%CI -5.72 至 7.85，p=0.8）有显著差异。应答者的比例也没有差异：AC 组 17%，WL 组 11%（6%差异，95%CI -10 至 22%，p=0.5）。未报告严重不良事件。
我们的针灸方案似乎安全且耐受良好。然而，它并没有显著减轻同时接受淋巴水肿治疗的预处理患者的 BCRL。对于患有持续性 BCRL 的乳腺癌幸存者，这种方案并没有改善常规的淋巴水肿治疗。
