Effective Treatment Approaches for Breast Cancer-Related Lymphedema.

BACKGROUND

Breast cancer related lymphedema (BCRL) is a distressing problem in breast cancer survivors. Chang and colleagues attempted to develop evidence based statements and recommendations for physiological technique is superior to another in lymphedema treatment and no procedure is more effective than others.

OBJECTIVES

This study aimed to evaluate the results of the physiologic techniques to develop an algorithm for use in the management of breast cancer-related lymphedema.

METHODOLOGY: This was a prospective case series study conducted on 23 patients. First, all patients underwent duplex ultrasonography (US) to detect the main component of the edema. If fluid was predominant, Indocyanine Green (ICG) lymphography was performed to choose which technique would be used after proper compression decongestive therapy.

RESULTS

In this study all cases showed postoperative significant improvement in International Society of Lymphology (ISL) staging, cellulitis attacks, and quality of life, as well as improvement in circumference measurements. This study showed that cases with dermal backflow better to be managed with Vascularized Lymph Node Transfer (VLNT), while those showing a linear pattern by ICG better managed by Lymphaticovenular Anastomosis (LVA).

CONCLUSION

Physiologic operations are effective in downstaging lymphedema, improving social quality of life, and decreasing or preventing cellulitis attacks. Our algorithm integrates clinical assessment and staging, ICG staging, and ultrasound findings, which allows a tailored management plan for each patient, achieving the greatest gains in functional outcome and cosmesis.