• 대한한방내과학회지
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• 제34권3호
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• pp.322-328
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• 2013

Objectives : The purpose of this study was to report two cases which suggest Oryeongsan as a pharmacological treatement option for cancer-induced secondary lymphedema. Methods : The cases were two female patients with peripheral edema. The first was diagnosed with cervical cancer with paraaortic lymph node metastasis and suffered from bilateral edema of the lower extremities. The second was a breast cancer patient with right arm lymphedema, which was aggravated after a weekly regimen of chemotherapy. Oryeongsan was orally administered for 3-4 days to both patients. Results : The symptoms in lower extremities and body weight of the cervical cancer patient decreased. The breast cancer patient did not lose body weight, but pain in upper extremities was reduced. Conclusions : Oryeongsan may potentially be an option for secondary lymphedemas, including cancer-induced lymphedema.

• 대한한방부인과학회지
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• 제32권3호
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• pp.102-115
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• 2019

Objectives: The purpose of this study is to confirm the effectiveness and safety of acupuncture for treating breast cancer-related lymphedema (BCRL), thus providing a clinical basis for acupuncture treatment and helping to develop clinical practice guideline through consideration of used meridians and acupoints. Methods: Clinical studies applying acupuncture on breast cancer-related lymphedema were searched through 7 databases such as The Cochrane Library Central, Embase, Pubmed and CAJ. Interventions and results of the selected clinical studies were analyzed. Results: 8 Clinical studies were finally included according to inclusion and exclusion criteria. There were 6 randomized controlled studies and 2 single-arm pilot studies. All of those studies were searched in The Cochrane Library Central, Embase, Pubmed and CAJ and written in English and Chinese. Treatment group applied acupuncture as a Korean medicine intervention. Interventions of control group were made with non-treatment, upper limb exercise, and oral administration of capillary stabilizer or diuretics. Outcome measurements varied from paper to paper but every study measured reduction in arm circumference. Among 8 studies, 6 studies reported statistically significant reduction in arm circumference in treatment group and there were no serious adverse effects. Conclusions: This study suggested that acupuncture has few side effects as well as statistically significant effects on many aspects in treating breast cancer-related lymphedema. However the results should be taken cautiously as more clinical studies are needed.

• Clinical Pain
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• 제20권1호
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• pp.25-29
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• 2021

Upper limb morbidity including shoulder pain, lymphedema, adhesive capsulitis, myofascial pain syndrome, and limited range of motions (LROMs) occurs frequently in breast cancer patients. Especially restricted upper limb motion aggravated by chronic lymphedema results in functional limitation and impaired activities of daily living (ADL). However, conventional rehabilitation therapy including complex decongestive therapy and stretching exercise is insufficient for managing advanced breast cancer patients with complex upper limb morbidity. Here, we report a case of breast cancer-related chronic lymphedema in a 62-years old female with severe LROM in all joints of the affected upper extremity that caused severe disability in ADL. Significant improvements in range of motion and upper extremity function were observed after serial extracorporeal shock wave therapy (ESWT), combined with conventional rehabilitation therapy. Therefore, ESWT might be recommended for managing the extensive limited joint motion which causes functional decline in a patient of chronic lymphedema with trophic skin change.

• Journal of Hospice and Palliative Care
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• 제21권4호
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• pp.158-162
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• 2018

유방암에 의한 림프부종은 유방암 수술 이후 생기는 치료하기 힘든 부작용 중 하나로 여겨져 왔다. 환자들은 림프부종에 의한 신체적인 기능저하뿐만 아니라 삶의 질 저하로 인한 정신적인 우울감을 호소한다. 최근의 연구에서는 봉와직염이 유방암에 의한 림프부종의 위험성을 현저히 높인다는 결과가 있었고, 봉와직염 자체가 유방암에 의한 림프부종을 일으키는 위험 인자로 제시되어 왔다. 본 증례에서는 1달간의 성상신경절 블록으로 유방암에 의한 염증성 림프부종 환자의 증상 완화 및 팔 둘레의 현저한 감소에 대해 기술 하고자 한다. 우리는 환자의 팔 둘레를 4군데에서 측정하였는데 각각 팔꿈치를 기준으로 위 아래 5 cm, 10 cm에서 측정이 이루어졌다. 또한 통증 점수(NRS) 와 breast cancer questionnaire (LBCQ) 점수를 외래 방문마다 측정하였다. 두 번의 연속적인 성상신경절 블록 이후 환자의 통증 점수 및 팔 둘레는 감소하였고, 치료 중간에 봉와직염이 재발하여 다시 입원하여 항생제 치료와 병행하여 연속적인 성상신경절 블록을 시행하였고 환자는 시술의 결과에 대해 매우 만족하였다. 특히 환자는 통증 및 붓기의 완화와 어깨 관절의 움직임 개선에 큰 만족을 보였고, 결과적으로 환자의 삶의 질을 높이는데 기여하였다. 본 증례는 유방암에 의한 염증성 림프부종에 대한 성상신경절 블록의 효과에 대한 연구로, 스테로이드를 사용하지 않는 성상신경절 블록이 치료하기 힘든 염증성 림프부종 환자의 대체적이면서 보조적인 치료 방법으로 제시 될 수 있다는 것을 보여준다.

• The Korean Journal of Pain
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• 제28권1호
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• pp.61-63
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• 2015

Lymphedema of the upper limb after breast cancer surgery is a disease that carries a life-long risk and is difficult to cure once it occurs despite the various treatments which have been developed. Two patients were referred from general surgery department for intractable lymphedema. They were treated with stellate ganglion blocks (SGBs), and the circumferences of the mid-point of their each upper and lower arms were measured on every visit to the pain clinic. A decrease of the circumference in each patient was observed starting after the second injection. A series of blocks were established to maintain a prolonged effect. Both patients were satisfied with less swelling and pain. This case demonstrates the benefits of an SGB for intractable upper limb lymphedema.

• Archives of Plastic Surgery
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• 제47권4호
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• pp.305-309
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• 2020

Breast cancer treatment-related lymphedema (BCRL) is a common comorbidity in breast cancer survivors. Although magnetic resonance imaging (MRI) is widely used to evaluate therapeutic response of patients with various medical conditions, it is not routinely used to evaluate lymphedema patients. We conducted a systematic review of the literature to identify studies on the use of MRI to evaluate therapy for BCRL. We hypothesized that MRI could provide information otherwise not possible through other examinations. On October 21, 2019, we conducted a systematic review on the PubMed/MEDLINE and Scopus databases, without time frame or language limitations, to identify studies on the use of MRI to evaluate therapy for BCRL. We excluded studies that investigated other applications of MRI, such as lymphedema diagnosis and surgical planning. Of 63 potential articles identified with the search, three case series fulfilled the eligibility criteria. In total, 53 patients with BCRL were included and quantitatively evaluated with MRI before and after manual lymphatic drainage. Authors used MRI or MR lymphagiography to investigate factors such as lymphatic vessel cross-sectional area, tissue water relaxation time (T₂), and chemical exchange saturation transfer. The only study that compared MRI measurement with standard examinations reported that MRI added information to the therapy evaluation. MRI seems to be a promising tool for quantitative measurement of therapeutic response in patients with BCRL. However, the identified studies focused on only manual lymphatic drainage and were limited by the small numbers of patients. More studies are necessary to shed light on the topic.

• The Korean Journal of Pain
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• 제35권3호
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• pp.280-290
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• 2022

Background: This study aimed to determine the impact of complex decongestive therapy applications on upper extremity function in breast cancer patients who developed adhesive capsulitis after lymphedema. Methods: Thirty patients who developed adhesive capsulitis due to lymphedema were divided into two groups as study (n = 15) and control (n = 15) groups. Both groups received 20 minutes of exercise five days a week for three weeks using a Biodex isokinetic dynamometer, as well as a hot pack and TENS (Transcutaneous Electrical Nerve Stimulation) treatment to the shoulder joint. The study group received 45 minutes of intensive decongestive therapy along with the adhesive capsulitis treatment. The visual analogue scale was used to assess pain, circumference, and volumetric measurements were used to assess edema, and the Arm, Shoulder, and Hand Problems Questionnaire (DASH: Disabilities of the Arm, Shoulder, and Hand) was used to assess upper extremity functionality. The shoulder range of motion was evaluated. Results: Both groups had improvements in pain (P < 0.001), shoulder joint range of motion (P < 0.001), and upper extremity functionality (P < 0.001) after the treatment. There was a significant decrease in circumference and volumetric measurements in the study group (P < 0.001). However, no differences were seen in measurements in the control group. Conclusions: The results showed that complex decongestive therapy was beneficial in reducing lymphedema in breast cancer patients who acquired adhesive capsulitis due to lymphedema. Consequently, the authors believe that supplementing conventional physiotherapy with complex decongestive therapy will benefit patients.

• Journal of Hospice and Palliative Care
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• 제6권2호
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• pp.177-179
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• 2003

Lymphedema is the most common of complications after surgery and radiotherapy in patients with breast cancer or cervical cancer. The cancer itself is a worry, but the lymphedema ia an additional handicap for the patients, both physical and psychosoical. Recently the best treatment of lymphedema is complete lymphedema therapy, and Dr. Foldi developed in 1980s. But this treatment has not always given satisfactory and permanent results. We report a case of the lymphedema patient who was treated by partial decompression therapy.

• Archives of Plastic Surgery
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• 제48권3호
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• pp.246-253
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• 2021

In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient's pathology, the treatment plan should be carefully decided and individualized. At the authors' institution, the treatment plan is made individually based on each patient's symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient's pathophysiology, optimal outcomes can be achieved. Depending on each patient's pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.

• Archives of Plastic Surgery
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• 제50권3호
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• pp.288-304
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• 2023

Background Untreated lymphedema of an extremity leads to an increase in volume. The therapy of this condition can be conservative or surgical. Methods "Lymphological liposculpture" is a two-part procedure consisting of resection and conservative follow-up treatment to achieve curative volume adjustment of the extremities in secondary lymphedema. This treatment significantly reduces the need for complex decongestive therapy (CDT). From 2005 to 2020, 3,184 patients with secondary lymphedema after breast cancer and gynecological tumors were treated in our practice and clinic. "Lymphological liposculpture" was applied to 65 patients, and the data were recorded and evaluated by means of perometry and questionnaires. Results The alignment of the sick to the healthy side was achieved in all patients. In 58.42% (n = 38), the CDT treatment could be completely stopped postoperatively; in another 33.82% (n = 22) of the patients, a permanent reduction of the CDT was achieved. In 7.69% (n = 5) patients, the postoperative CDT could not be reduced. A total of 92.30% (n = 60) of the patients described a lasting significant improvement in their quality of life. Conclusion "Lymphological liposculpture" is a standardized curative sustainable procedure for secondary lymphedema for volume adjustment of the extremities and reduction of postoperative CDT with eminent improvement of the quality of life.