title: Double-blind placebo-controlled randomised trial of vitamin E and pentoxifylline in patients with chronic arm lymphoedema and fibrosis after surgery and radiotherapy for breast cancer.
abstract: OBJECTIVE
  Treatment-induced arm lymphoedema is a common and distressing complication of curative surgery and radiotherapy for early breast cancer. A number of studies testing alpha-tocopherol (vitamin E) and pentoxifylline suggest evidence of clinical regression of superficial radiation-induced fibrosis but there is only very limited evidence from randomised trials. Arm lymphoedema after lymphatic radiotherapy and surgery has been used in the present study as a clinical system for testing these drugs in a double-blind placebo-controlled randomised phase II trial.
  
  
  METHODS
  Sixty-eight eligible research volunteers with a minimum 20% increase in arm volume at a median 15.5 years (range 2-41) after axillary/supraclavicular radiotherapy (plus axillary surgery in 51/68 (75%) cases) were randomised to active drugs or placebo. All volunteers were given dl-alpha tocopheryl acetate 500 mg twice a day orally plus pentoxifylline 400 mg twice a day orally, or corresponding placebos, for 6 months. The primary endpoint was volume of the ipsilateral limb measured opto-electronically using a perometer and expressed as a percentage of the contralateral limb volume.
  
  
  RESULTS
  At 12 months post-randomisation, there was no significant difference between treatment and control groups in terms of arm volume. Absolute change in arm volume at 12 months was 2.5% (95% CI -0.40 to 5.3) in the treatment group compared to 1.2% (95% CI -2.8 to 5.1) in the placebo group. The difference in mean volume change between randomisation groups at 12 months was not statistically significant (P = 0.6), -1.3% (95% CI -6.1 to 3.5), nor was there a significant difference in response at 6 months (P = 0.7), where mean change in arm volume from baseline in the treatment and placebo groups was -2.3% (95% CI -7.9 to 3.4) and -1.1% (95% CI -3.9 to 1.7), respectively. There were no significant differences between randomised groups in terms of secondary endpoints, including tissue induration (fibrosis) in the irradiated breast or chest wall, pectoral fold or supraclavicular fossa, change in photographic breast/chest wall appearance or patient self-assessment of function and Quality of Life at either 6 or 12 months.
  
  
  CONCLUSIONS
  The study fails to demonstrate efficacy of dl-alpha tocopheryl acetate plus pentoxifylline in patients with arm lymphoedema following axillary surgery and lymphatic radiotherapy, nor does it suggest any benefits of these drugs in radiation-induced induration (fibrosis) in the breast, chest wall, pectoral fold, axilla or supraclavicular fossa.
authors.affiliation: Department of Radiotherapy, Royal Marsden Hospital, Sutton, Surrey, UK.
authors.forename: Lone
authors.initials: L
authors.lastname: Gothard
authors.forename: Paul
authors.initials: P
authors.lastname: Cornes
authors.forename: Judith
authors.initials: J
authors.lastname: Earl
authors.forename: Emma
authors.initials: E
authors.lastname: Hall
authors.forename: Julie
authors.initials: J
authors.lastname: MacLaren
authors.forename: Peter
authors.initials: P
authors.lastname: Mortimer
authors.forename: John
authors.initials: J
authors.lastname: Peacock
authors.forename: Clare
authors.initials: C
authors.lastname: Peckitt
authors.forename: Mary
authors.initials: M
authors.lastname: Woods
authors.forename: John
authors.initials: J
authors.lastname: Yarnold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005355:Fibrosis / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D008209:Lymphedema / Q000188:drug therapy* / Q000209:etiology; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D010431:Pentoxifylline / Q000627:therapeutic use*; D011336:Probability; D011788:Quality of Life; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D016896:Treatment Outcome; D014810:Vitamin E / Q000627:therapeutic use*
chemical_list: D014810:Vitamin E; D010431:Pentoxifylline