Gynecol Oncol Rep. 2024 Oct 20;56:101534. doi: 10.1016/j.gore.2024.101534. eCollection 2024 Dec.

ABSTRACT

OBJECTIVE: Radiation therapy (RT) for gynecological cancers has significant effects on patients’ quality of life regarding sexual dysfunction, urinary incontinence (UI), fecal incontinence (FI), and psychological distress. There is a scarcity in literature for the inclusive therapeutic approaches of pelvic health physical therapy (PHPT) for cancer survivors. Therefore, this case describes a comprehensive PHPT program to address the complexity of pelvic floor dysfunctions due to RT.

CASE DESCRIPTION: A 54-year-old female was diagnosed with high-grade neuroendocrine carcinoma of the vagina. After a one-year treatment of chemotherapy and RT, the patient presented with overall fatigue, psychological distress, dyspareunia, mixed UI, fecal urgency and FI, and bilateral vulvar lymphedema. The PHPT exam revealed vaginal dryness, vulvovaginal fibrosis, and pelvic floor muscle (PFM) weakness.A comprehensive treatment approach included referrals to multidisciplinary specialists. PHPT incorporated motor learning, strengthening and stretching of PFM, internal and external fascia mobilization for PFM and vulvar tissues, lymphatic drainage, vaginal dilators, pain neuroscience education and nutrition recommendations. After seven sessions, the patient demonstrated improved PFM strength, improved psychosocial measures, no UI or FI, as well as reduced discomfort during intercourse.

CONCLUSIONS: Symptoms were clinically improved with a multidisciplinary approach and comprehensive PHPT. However, considering the consistency and time required for physiological and psychological recovery for gynecological cancer survivors, it was recommended to continue the plan of care and home program developed to address the patient’s goals.

IMPACT STATEMENT: Treatment utilized a holistic and interdisciplinary approach to address the multifactorial nature of vaginal cancer and side effects of RT. PHPT, which promptly maximized improvement, included manual therapy, exercises, education, and motivational interviewing strategies that prioritized the patient’s goals and built a nurturing clinician-patient relationship. Health care providers are strongly encouraged to refer to PHPT as interventions may significantly improve the patient’s quality of life.This case report follows the CARE Guidelines (Riley et al., 2017).

PMID:39524472 | PMC:PMC11550129 | DOI:10.1016/j.gore.2024.101534

Med Oncol. 2024 Oct 23;41(11):297. doi: 10.1007/s12032-024-02421-6.

ABSTRACT

Breast cancer-related lymphedema (BCRL) remains a challenging condition impacting function and quality of life. Complete decongestive therapy (CDT) is the current standard of care, necessitating a comprehensive review of its impact. This paper presents a systematic review (SR) of SRs on CDT’s efficacy in BCRL, and the components of manual lymph drainage (MLD) and exercise. A literature search yielded 13 SRs published between January 2018 and March 2023 meeting inclusion criteria, with varied quality ratings based on the AMSTAR II. A sub-analysis of CDT investigated the within group effect size estimations on volume in different stages of lymphedema. While a moderate quality SR indicated support for CDT in volume reduction, other SRs on the topic were of critically low quality. Larger effect sizes for CDT were found for later stage BCRL. The impact of MLD as a component of CDT demonstrated no additional volume benefit in a mix of moderate to low quality SRs. Similarly, exercise’s role in volume reduction in CDT was limited, although it demonstrated some benefit in pain and quality of life. A rapid review of trials published January 2021-March 2023 reinforced these findings. Variability in CDT delivery and outcomes remained. These findings underscore the need to standardize staging criteria and outcome measures in research and practice. Future research should focus on refining interventions, determining clinically important differences in outcomes, and standardizing measures to improve evidence-based BCRL management. Current evidence supports CDT’s efficacy in BCRL. MLD and exercise as components of CDT have limited support for volume reduction.

PMID:39438358 | PMC:PMC11496316 | DOI:10.1007/s12032-024-02421-6

NPJ Microgravity. 2024 Oct 3;10(1):93. doi: 10.1038/s41526-024-00429-w.

ABSTRACT

This retrospective case series (clinicaltrials.gov NCT06405282) used noninvasive imaging devices (NIID) to assess the effect of manual lymphatic drainage (MLD) on dermal/venous fluid distribution, perfusion, and temperature alterations of the head, neck, upper torso, and legs while in the 6-degree head-down tilt validated spaceflight analog. A lymphatic fluid scanner measured tissue dielectric constant levels. Near-infrared spectroscopy assessed perfusion, by measuring tissue oxygenation saturation. Long-wave infrared thermography measured tissue temperature gradients. Fifteen healthy, university students participated. NIID assessments were taken 1 minute after assuming the HDT position and then every 30 minutes, with MLD administered from 180 to 195 minutes. Subjects returned to the sitting position and were assessed at post-225 min NIID demonstrated significant changes from baseline (p < 0.01), although these changes at areas of interest varied. MLD had a reverse effect on all variables. NIID assessment supported the potential use of MLD to mitigate fluid shifts during a spaceflight analog.

PMID:39362907 | PMC:PMC11450199 | DOI:10.1038/s41526-024-00429-w

BMC Urol. 2024 Sep 4;24(1):192. doi: 10.1186/s12894-024-01533-5.

ABSTRACT

BACKGROUND: Patients undergoing treatment for prostate cancer may develop lymphoedema of the midline region. This has a substantial impact on a patient’s quality of life and its diagnosis is often delayed or missed. Therefore, the purpose of this study is to compare the characteristics of patients with leg and midline lymphoedema to patients with only leg lymphoedema.

METHODS: We retrospectively collected patient-, cancer-, lymphoedema- and lymphoedema treatment-related data of 109 men with lymphoedema after treatment for prostate cancer. First, 42 characteristics were compared between both groups. Second, factors predicting presence of midline lymphoedema were explored by multivariable analyses.

RESULTS: The mean age of the patients with lymphoedema was 68 ( ±7) years and mean BMI is 28 (±4) kg/m². Median duration of lymphoedema before the first consultation was 27 (9;55) months. Based on univariable analyses, patients with leg and midline lymphoedema had more frequently upper leg lymphoedema (89% (31/35) vs. 69% (51/74), p = 0.026), skin fibrosis (34% (12/35) vs. 16% (12/74), p = 0.034) and lymphatic reconstructive surgery (9% (3/35) vs. 0% (0/71), p = 0.020) than patients with only leg lymphoedema. Additionally, patients with leg and midline lymphoedema reported less frequently lower leg lymphoedema (77% (27/35) vs. 95% (70/74), p = 0.007). Based on the multivariable analysis, not having lower leg lymphoedema, skin fibrosis, performing self-bandaging and self-manual lymphatic drainage appear to be predictors for having midline lymphoedema.

CONCLUSIONS: If patients with lymphoedema after prostate cancer do not have lower leg lymphoedema, have skin fibrosis, perform self-bandaging or self-manual lymphatic drainage, they possibly have midline lymphoedema.

PMID:39232687 | PMC:PMC11373232 | DOI:10.1186/s12894-024-01533-5

Front Med Technol. 2024 Jul 17;6:1397561. doi: 10.3389/fmedt.2024.1397561. eCollection 2024.

ABSTRACT

INTRODUCTION: Automated manual lymphatic drainage therapy (AMLDT) is available for home use in the form of a pneumatic mat of 16 pressurized air channels that inflate and deflate to mimic the stretch and release action of manual lymphatic drainage therapy. Four cases (a patient with complex regional pain syndrome and lymphedema, a healthy patient, a breast cancer survivor with chronic pain, and a patient with a history of abdominal surgery) underwent near-infrared fluorescence lymphatic imaging (NIRFLI) with AMLDT to evaluate the effect of AMLDT on lymphatic pumping and pain.

METHODS: Each patient received 32-36 injections of 25 μg indocyanine green (ICG) on the anterior and posterior sides of their body and underwent 1 h of NIRFLI to assess the drainage of ICG laden lymph toward regional nodal basins at baseline. Each patient lay supine on the mat for 1 h of AMLDT with NIRFLI to assess lymphatic flow during treatment. A final NIFRFLI assessment was done 30-60 min posttreatment with the patient in the supine and prone position. Patients reported baseline and posttreatment pain using the Visual Analogue Scale. An imager analyzed NIRFLI images using ImageJ (US National Institutes of Health). Using time stamps of the first and last images to determine time lapsed and the number of pulses observed in a timeframe, pulsing frequency (pulses/min) was obtained to assess lymphatic function.

RESULTS: All 4 cases completed the NIRFLI and AMLDT without complications; all 3 patients with baseline pain reported reduced pain posttreatment. AMLDT appeared to alter lymphatic contractility, with both increased and decreased pulsing frequencies observed, including in nonaffected limbs. Pulsing frequencies were very heterogeneous among patients and varied within anatomic regions of the same patient.

DISCUSSION: This proof-of-concept study suggests that AMLDT may impact lymphatic contractility. Further research on its effect on lymphatic function is warranted.

PMID:39091568 | PMC:PMC11292613 | DOI:10.3389/fmedt.2024.1397561

Cancers (Basel). 2024 Jul 2;16(13):2435. doi: 10.3390/cancers16132435.

ABSTRACT

We appreciate the commentary by Pierre Bourgeois […].

PMID:39001497 | PMC:PMC11240713 | DOI:10.3390/cancers16132435

Cancers (Basel). 2024 Jul 2;16(13):2434. doi: 10.3390/cancers16132434.

ABSTRACT

This study is a comment on the non-effectiveness of fluoroscopy-guided manual lymph drainage using ICG as part of decongestive lymphatic therapy on the superficial lymphatic architecture in patients with breast cancer-related lymphoedema in a randomized controlled trial, and the demonstration of one toxicity of indocyanine green on the lymphatic system […].

PMID:39001496 | PMC:PMC11240381 | DOI:10.3390/cancers16132434

World J Clin Cases. 2024 Jul 6;12(19):3971-3977. doi: 10.12998/wjcc.v12.i19.3971.

ABSTRACT

BACKGROUND: Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder that affects the synovial joints, bursae, and tendon sheaths. To date, few studies have reported on the treatment of postoperative pain and edema in patients with PVNS. Herein, we present the case of a woman who developed pain and edema in the left lower limb 1 wk after synovectomy and arthroscopic partial meniscectomy and was unable to walk due to limited flexion and extension of the left knee.

CASE SUMMARY: A 32-year-old woman underwent synovectomy and arthroscopic partial meniscectomy successively and was treated with a combination of manual lymphatic drainage (MLD) and kinesio taping (KT) in our hospital to alleviate postoperative pain and edema. The following parameters were assessed at 2 wk post-treatment and 1 wk post-discharge follow up: suprapatellar circumference, infrapatellar circumference, visual analog scale score, knee range of motion, pittsburgh sleep quality index score, hamilton anxiety rating scale (HAMA) score, and hamilton depression rating scale (HAMD) score. After treatment, the postoperative pain and edema in the patient’s left knee were effectively relieved, resulting in improved sleep quality and remarkably attenuated HAMA and HAMD scores.

CONCLUSION: Combined MLD and KT may be an effective approach for relieving postoperative pain and edema in patients with PVNS.

PMID:38994276 | PMC:PMC11235440 | DOI:10.12998/wjcc.v12.i19.3971

Plast Reconstr Surg Glob Open. 2024 Jul 2;12(7):e5952. doi: 10.1097/GOX.0000000000005952. eCollection 2024 Jul.

ABSTRACT

BACKGROUND: Lipedema is the progressive symmetrical deposition of subcutaneous fat and fluid in the lower body, ordinarily sparing the trunk, upper limbs, face, and neck. It may follow an autosomal dominant inheritance pattern. The gold standard treatment for lipedema is complete decongestive therapy, consisting of manual lymphatic drainage and compression garments. This scoping review assessed the existing literature on the effectiveness of liposuction as an alternative treatment for lipedema.

METHODS: A scoping review of electronically available literature within PubMed, Scopus, and Cochrane focused on liposuction as a treatment for lipedema considering the following inclusion criteria: human studies, case series of 10 or more, controlled trials, randomized controlled trials, patient-reported outcome measurement studies, survey analyses, descriptive studies, retrospective analyses, recurrence included, follow-up of 6 months or more, age 18 years or older, and treatment modality being liposuction.

RESULTS: Thirteen studies were selected. Nine studies reported decreased compression therapy use among patients following liposuction. No studies reported a long-term increase in compression therapy following liposuction. Studies found self-reported improvements in pain, mobility, bruising, and overall quality of life for patients following liposuction, many of whom had previously been on compressive therapy. Studies reported low rates of serious adverse events following liposuction, including deep vein thrombosis, pulmonary embolism, and infection.

CONCLUSIONS: These results suggest that liposuction can be a viable treatment alternative to compression therapy for lipedema in patients whose compression therapy has not been helpful. However, there is not enough evidence to say whether liposuction is as effective as compression for patients first presenting with lipedema.

PMID:38957726 | PMC:PMC11219175 | DOI:10.1097/GOX.0000000000005952

Ann Vasc Dis. 2024 Jun 25;17(2):114-119. doi: 10.3400/avd.ra.24-00011. Epub 2024 Mar 13.

ABSTRACT

Lymphedema is caused by dysfunction of the lymphatic system. It is divided into primary edema with no apparent cause and secondary edema with an exogenous cause. The main symptoms are edema and heaviness, skin changes such as skin hardening, lymphocysts, lymphorrhoea, papillomas, and recurrent cellulitis. They are often irreversible and progressive, thus greatly reducing quality of life of the patients. Diagnosis is made by image examinations that can evaluate lymphatic flow and functions such as lymphoscintigraphy and indocyanine green fluorescence lymphangiography. Linear pattern and dermal backflow are the main findings. Conservative treatment consists of four components: compression therapy with elastic garments, exercise therapy, manual lymphatic drainage, and skin care, which is called complex physical therapy (CPT). Although CPT has become the gold standard of treatment, with evidence of efficacy reported in terms of volume reduction, maintenance, and prevention of cellulitis, it is a symptomatic treatment and does not improve impaired lymphatic flow. On the other hand, surgical treatment, such as lymphaticovenous anastomosis and vascularized lymph node transplantation, can create new lymphatic flow and improve lymphatic dysfunctions. Although these techniques are expected to be effective in volume reduction, cellulitis prevention, and improving quality of life, there is a need for more studies with a higher level of evidence in the future. In Japan, lymphedema is treated with a combination of conservative and surgical therapies, but lymphedema is intractable and few cases are completely cured. Therefore, how to improve the outcome of treatment is an important issue to be addressed in the future. (This is a translation of Jpn J Vasc Surg 2023; 32: 141-146.).

PMID:38919315 | PMC:PMC11196164 | DOI:10.3400/avd.ra.24-00011