Department of Rehabilitation, The First Hospital of Lanzhou University, No. 1 Donggang West Road, Chengguan District, Lanzhou, 730000, People's Republic of China.
Lasers Med Sci. 2022 Apr;37(3):1389-1413. doi: 10.1007/s10103-021-03446-3. Epub 2021 Nov 15.
The objective of our overview of systematic reviews was to critically analyze the evidence from existing systematic reviews investigating the effectiveness and safety of low-level laser therapy (LLLT) in patients with breast cancer-related lymphedema (BCRL). In addition, an updated and comprehensive systematic review was conducted, which aimed to provide updated evidence about this topic. PubMed, EMBASE, and Cochrane Library databases were systematically searched for systematic reviews and randomized controlled trials (RCTs) investigating the effectiveness and safety of LLLT in patients with BCRL. The methodological quality for each of included systematic reviews or RCTs was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) tool or Cochrane risk of bias tool, respectively. The updated systematic review separately compared the effectiveness of LLLT to each of active or negative interventions. Data were pooled with random-effects models for each outcome per comparison. The evidence quality of outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) or GRADE-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) for quantitative studies and qualitative studies, respectively. Seven systematic reviews and ten RCTs met the eligibility criteria. Conflicting results regarding the effectiveness of LLLT were presented by the overview of systematic reviews. The AMSTAR 2 showed that the methodological quality of included systematic reviews was low or critically low quality due to one or more critical weaknesses. The GRADE and GRADE-CERQual showed that the evidence quality was low to very low for most outcomes. The updated systematic review showed that LLLT may offer additional benefits as compared to compression therapies (pneumatic compression or compression bandage), placebo laser, or no treatment for patients with BCRL. However, when compared to other types of active interventions, LLLT did not improve outcomes significantly. None of the treatment-related adverse event was reported. Many trials had a high or unclear risk of bias for two or more items, and our updated systematic review showed low quality of evidence per outcome using GRADE approach. Due to insufficient data and poor quality of evidence, there is uncertain to reach these conclusions that LLLT is superior to another active or negative intervention and is safe. More RCTs of high methodological quality, with large sample sizes and long-term follow-up, are needed to inform clinical guidelines and routine practice.
我们对系统评价的综述的目的是批判性地分析现有系统评价中关于低水平激光治疗（LLLT）治疗乳腺癌相关淋巴水肿（BCRL）患者的有效性和安全性的证据。此外，我们还进行了更新和全面的系统评价，旨在提供关于该主题的最新证据。我们系统地检索了 PubMed、EMBASE 和 Cochrane Library 数据库，以查找调查 LLLT 治疗 BCRL 患者有效性和安全性的系统评价和随机对照试验（RCT）。使用评估系统评价的方法学质量 2 工具（AMSTAR 2）或 Cochrane 偏倚风险工具分别评估纳入的系统评价或 RCT 的方法学质量。更新的系统评价分别比较了 LLLT 与每种积极或消极干预措施的效果。对于每个比较，使用随机效应模型汇总每个结局的数据。使用推荐评估、制定与评价分级（GRADE）或定性研究的证据质量（GRADE-CERQual）分别评估结局的证据质量。有 7 项系统评价和 10 项 RCT 符合纳入标准。系统评价综述呈现了关于 LLLT 有效性的相互矛盾的结果。AMSTAR 2 显示，由于存在一个或多个关键缺陷，纳入的系统评价的方法学质量低或极低。GRADE 和 GRADE-CERQual 显示，大多数结局的证据质量为低到极低。更新的系统评价显示，与压缩治疗（气动压缩或压缩绷带）、安慰剂激光或不治疗相比，LLLT 可能为 BCRL 患者提供额外的益处。然而，与其他类型的积极干预相比，LLLT 并没有显著改善结局。没有报告任何与治疗相关的不良事件。许多试验在两个或更多项目上存在高或不清楚的偏倚风险，我们使用 GRADE 方法对每个结局的更新系统评价显示证据质量低。由于数据不足和证据质量差，目前还不能得出 LLLT 优于另一种积极或消极干预且安全的结论。需要更多高质量、大样本量和长期随访的 RCT，以为临床指南和常规实践提供信息。
