Nehir SAMANCI, Özlem KARATAŞ, Ayşegül SAMUR, Ali ÇİPLİ, Nilüfer BALCI

Meme kanseri ilişkili lenfödem ve kompleks dekonjestif tedavisi etkinliği: Kesitsel çalışma

Amaç: Lenfödem lenfatik dolaşımının bozulması sonucu, proteinden zengin interstisiyel sıvının birikimiyle karakterize bir durumdur. Meme kanseri ilişkili lenfödem genellikle aksiller lenf nodu diseksiyonu ve/veya aksiller radyasyon sonucu üst ekstremitenin lenfatik drenajının bozulması nedeniyle oluşur. Tedavi yaklaşımları, ekstremitedeki şişliğin azaltılması, semptomların kontrolü ve komplikasyonlarn azaltılmasına yöneliktir. Bu çalışmadaki amacımız meme kanseri ilişkili lenfödem ve kompleks dekonjestif tedavisi (KDT) etkinliğini araştırmaktır.Yöntemler: Meme kanserine bağlı olarak cerrahi müdahale, axiller lenf nodu diseksiyonu,radioterapi ve/veya kemoterapi almış ve üst ektremitede lenf ödem gelişen, 15-30seans KDT uygulanan ve ayrıca rehabilitasyon öncesi ve sonrası değerlendirmeleri eksiksiz yapılan hastaların dosyaları değerlendirmeye alındı. Tüm hastaların lenfödemin tanı ve takibinde etkilenen ve sağlam ekstremitenin çevre ölçümleri aracılığıyla elde edilen volümetrik ölçümler kullanıldı. Hastaların tedavi öncesi ve sonrası sağlam ve etkilenen ekstremitelerinin çevre ölçümlerinden faydalanarak ekstremite volümleri hesaplandı ve kaydedildi.Bulgular: Yapmış olduğumuz bu retrospektif araştırmada belirtilen kriterler ile uyumlu 47 hastanın verileri değerlendirmeye alındı. Lenfödem tedavisi öncesi ve sonrasındaki tutulan ekstremitedeki volüm değişimleri incelendiğinde ise KDT sonrasında lenfödem miktarının anlamlı derecede azalmış olduğu tespit edildi (P=0.001). Değerlendirmeye alınan hastalardan 31’i (%66) mastektomi sonrası radyoterapi almıştı. Hastalar postoperatif radyoterapi alma durumuna göre KDT öncesi ve sonrası ekstremitede meydana gelen volümetrik değişim açısından karşılaştırıldığında radyoterapi almayan hasta grubundaki değişimin radyoterapi alanlardan anlamlı derecede daha fazla olduğu belirlendi (P=0.01).Sonuç: Çalışmamızın sonuçları KDT tedavisinin lenfödem tedavisinde etkin bir tedavi yöntemi olduğunu göstermiştir. Gelecek zamanda kompleks dekompresif tedavinin komponentlerinin etkinliğini değerlendirilebilmek için uzun takip süreli kontrollü çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Lenfödem, Kompleks dekompresif tedavi, Meme kanseri

Efficacy of complex decongestive therapy on breast cancer-related lymphedema: A cross-sectional study

Aim: Lymphedema is a protein-rich interstitial fluid accumulation which occurs as a result disruption of lymphatic circulation. Breast cancer is a major reason of secondary cancer lymphedema. Breast cancer related upper extremity lymphedema result from the obstruction or disruption of the lymphatic system due to axillary lymph node dissection and/or radiation therapy of axillary region. A variety of conservative therapies have been aimed to decrease the limb swelling and its associated problems have been developed. Conservative treatments are complex decongestive therapy (CDT). The aim of our study was to investigate efficacy of CDT on the occurrence of breast cancer related lymphedema.Methods: Between 2009 and 2018, 47 consecutive patients with histologically proven breast cancer were first treated with breast surgery, axillary lymph node dissection and radiotherapy and/or chemotherapy. These were analyzed collectively with retrospective data of our medical records who had 15-30 set of CDT and who had complete assessments before and after the treatment. CDT consists of the following components; skin care, manual lymphatic drainage, bandaging and exercises. Patients were treated with active therapy schedule (manual massage for lymphatic drainage and exercise therapy, 45-60 min per day) by the same trained physiotherapist. Volumetric quantification by circumference measurement of affected and healthy extremities was used for diagnosis and follow-up of lymphedema in all patients.Results: The data of the 47 patients complying with the criteria specified in this retrospective study were evaluated. When the volumetric changes in the affected extremity were examined before and after lymphedema treatment, it was determined that the amount of lymphedema decreased after CDT (P=0.001). 31 (66%) patients received radiotherapy after mastectomy. When the patients were compared in terms of volumetric changes in extremities before and after CDT according to getting postoperative radiotherapy, it was determined that the changes in the patients who did not get radiotherapy were significantly higher than those getting radiotherapy (P=0.01).Conclusion: Our study results show that CDT can be used for the management of breast cancer related lymphedema of limb. A thorough cost-effective analysis of protocol for CDT should be performed in a future study. In addition, as the factors underlying treatment delay were not included in this study, we believe future studies examining this area may be beneficial.

Keywords:

Lymphedema, Complex decongestive therapy, Breast cancer,

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