Ümran MUSLU, Özcan ALTINEL, A. Serhat GÜR, Ayşegül DEMİR, Eyüp Sabri TEZCAN, Orhan ÜREYEN, Mustafa ATABEY, Ali Kağan GÖKAKIN

The efficacy of micronized flavonoid fraction (450 mg diosmin plus 50 mg hesperidin) in the treatment of lymphedema after axillary dissection

Amaç. Meme kanserinin cerrahi tedavisinde uygulanan yöntemlerden modifiye radikalmastektomi ve meme koruyucu cerrahi sonrasında görülen önemli komplikasyonlardan birisilenfödemdir. Mikronize Flavanoid Fraksiyon (MFF) (diosmin %90, hesperidin %10) venöz akımıve lenfatik akımı hızlandıran bir ajan olarak günümüzde kullanılmakta olan bir ilaçtır. Biz buçalışmada MFF 500 mg'ın lenfödem üzerine etkisini araştırmayı amaçladık. Yöntem. Bu amaçlakliniğimizde Temmuz 2001-Temmuz 2004 tarihleri arasında meme kanseri nedeniyle modifiyeradikal mastektomi veya meme koruyucu cerrahi uygulanan hastalar çalışmaya dâhil edildi.Operasyon sonrasında aksiller radyoterapi endikasyonu koyulan hastalar çalışma dışı bırakıldı.Hastalar 2 gruba randomize edildi. Grup 1: Kontrol: Bu hastalara operasyon sonrasında 6 ayplasebo verildi. Grup 2: MFF 500 mg: Bu hastalara operasyon sonrasında 6 ay MFF 500 mg 2x1verildi. Hastaların tamamının preoperatif ve postoperatif 1. ay, 3. ay ve 6. aylarında kol çapları vekol hacimleri ölçülerek kaydedildi. Operasyon tarafındaki % 10luk hacim ve/veya çap artışılenfödem olarak kabul edildi. Sonuçlar Mann Whitney U testi ile değerlendirildi. Bulgular. Grup1'de 30 hasta grup 2'de ise 24 hasta vardı. Gruplar arasında preoperatif kol çapları ve kol hacimleriaçısından istatistiksel olarak anlamlı fark yoktu. Diseke edilen lenf nodu sayıları her iki gruptaistatistiksel olarak farksızdı. Postoperatif lenfödem gelişimine baktığımızda grup 1'de 5 hastada(%16,6), grup 2'de ise 4 hastada %10,7 oranında lenfödem geliştiği görüldü. Bu oranlar arasındaistatistiksel olarak anlamlı fark yoktu. Gruplar arasında postoperatif 1. 3. ve 6. ay yapılan hacim veçap ölçümleri değerlendirildiğinde çap değişimi ve hacim değişimi açısından anlamlı farksaptanmadı. Sonuç. Sonuç olarak aksiller diseksiyon sonrasında gelişen lenfödemin önlenmesindeMFF etkisinin olmadığı ancak daha kesin sonuca varılması için daha büyük grupları içerençalışmaların gerektiği kanaatine varıldı.

Aksiller diseksiyon sonrası kolda gelişen lenf ödem p rof ilkasisinde mikronize flavonoid f raksiyonunun etkinliği

Aim. Lymphedema is one of the most important complications that occurs secondary to modifiedradical mastectomy and breast conserving surgery in breast cancer treatment. micronized flavonoidfraction (MFF) (diosmin 90%, hesperidin 10%) is a well known chemical agent used for theacceleration of the flow of lymphatic and venous drainage. Our goal was to evaluate the efficacyof MFF in the treatment of lymphedema. Method. Fifty-four patients who underwent modifiedradical mastectomy or breast conserving surgery, because of breast cancer between July 2001 andJuly 2004 in our clinic were included in the trial. The patients who required post operative axillaryradiotherapy were excluded. Patients were randomized into two groups. Groups were allocated asfollows: Group I (30 patients): Placebo treatment for six months was performed. Group II (24patients): Patients were treated with 2x1 .500 mg/day/p.o MFF for six months. The diameters andthe volumes of the patients arms were measured and recorded preoperatively and postoperativelyat the 1st, 3rd and 6th months. The 10% increase of diameter and/or volume in the arm at theoperation side was accepted as lymphedema. The results were evaluated by using Mann WhitneyU test. Results. There were 30 patients in group 1 and 24 patients in group 2. No statisticallysignificant difference was detected between the groups by means of preoperative diameter andvolume of the arms. Post operative dissected numbers of the lymph nodes were also not differentamong groups. Postoperative lymphedema was detected in 5 (16.6%) and 4 (10.7%) patients inGroup I and in Group II respectively. These results similarly showed no statistically significance.And also we detected no statistically difference between the two groups in the measurements ofthe arms at the1st, 3rd and 6th month control visits. Conclusion. As a result, the MFF in thetreatment of lymphedema can be accepted as ineffective but further investigations with largernumber of patients are required to confirm this conclusion.

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