Background: Complex decongestive therapy (CDT) is a proven lymphedema management method, but the effectiveness of the treatment may depend on the therapist’s capabilities and the patient’s education and compliance. Previous studies showed that extracorporeal shock wave therapy (ESWT) had been found effective in stimulating several endogenous growth factors. Furthermore, it was shown that ESWT regulates the activation of pro-fibrotic and anti-fibrotic proteins that are involved in fibrosis and finally improves lymphedema, upper-extremity functions and quality of life. The purpose of the present study is to show difference between the effect of CDT combined with ESWT and that of CDT alone in breast cancer-related lymphedema (BCRL) patients.
Methods: The present study enrolled stage 2 lymphedema patients who had hardness at their forearms and had circumference difference more than 2 centimeters between both arms, even though they had implemented phase 2 CDT (maintenance phase) by themselves. Subjects were randomly divided into two groups, ESWT group (EG) and conventional group (CG). In EG, ESWT was performed for three weeks (two sessions per week). In each session, a practitioner applied 1000 shocks to the most fibrotic lesion of the forearm and 1500 shocks to the cubital lymph nodes, the arm, the forearm, and the hand at an energy level of 0.056 to 0.068 mJ/mm2. During 3 weeks, phase 2 CDT including bandage and massage was maintained every night at home in both CG and EG. Before and after the three sessions, visual analogue scale, circumference and volume of the upper extremity were measured, and a shoulder and hand questionnaire (QuickDASH) was investigated to examine the functional status of both CG and EG patients' upper extremity. Body composition analyzer (InBodyⓇ, Seoul, Korea) was used to measure muscle mass and rate of water content in upper extremity as well as composition of total body water. In addition, skin thickness was measured at 10 centimeters below medial epicondyle. A skin fold caliper was used and measured values were compared with the unaffected side.
Results: Both groups had nine patients who completed 3 weeks therapy. No difference was identified in any of the demographics between the groups (Table 1). Statistically significant improvements were found in the below-elbow circumference, upper extremity volume, rate of total body water, and skin thickness in EG (Table 2). A significant difference was found in the improvement of the upper extremity volume and skin thickness between CG and EG, but not in the other measurements (Table 3). No complications were found in either group during this study.
Conclusion: ESWT reduced edema and resulted in functional improvement of the upper extremity without a specific complication in BCRL patients. Therefore, ESWT may be used as an additional treatment with CDT. Future studies with a larger number of participants should be necessary.
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