title: Efficacy of complete decongestive therapy and manual lymphatic drainage on treatment-related lymphedema in breast cancer.
abstract: OBJECTIVE
  To evaluate the results of combined decongestive therapy and manual lymphatic drainage in patients with breast cancer-related lymphedema.
  
  
  METHODS
  The data from 250 patients were reviewed. The pre- and posttreatment volumetric measurements were compared, and the correlation with age, body mass index, and type of surgery, chemotherapy, and radiotherapy was determined. The Spearman correlation coefficients and Wilcoxon two-sample test were used for statistical analysis.
  
  
  RESULTS
  Of the 250 patients, 138 were included in the final analysis. The mean age at presentation was 54.3 years. Patients were stratified on the basis of the treatment modality used for breast cancer management. Lymphedema was managed with combined decongestive therapy in 55%, manual lymphatic drainage alone in 32%, and the home program in 13%. The mean pretreatment volume of the affected and normal arms was 2929 and 2531 mL. At the end of 1 year, the posttreatment volume of the affected arm was 2741 mL. The absolute volume of the affected arm was reduced by a mean of 188 mL (p < 0.0001). The type of surgery (p = 0.0142), age (p = 0.0354), and body mass index (p < 0.0001) were related to the severity of lymphedema.
  
  
  CONCLUSIONS
  Combined decongestive therapy and manual lymphatic drainage with exercises were associated with a significant reduction in the lymphedema volume.
authors.affiliation: Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada. rashmi.koul@cancercare.mb.ca
authors.forename: Rashmi
authors.initials: R
authors.lastname: Koul
authors.forename: Tarek
authors.initials: T
authors.lastname: Dufan
authors.forename: Catherine
authors.initials: C
authors.lastname: Russell
authors.forename: Wanda
authors.initials: W
authors.lastname: Guenther
authors.forename: Zoan
authors.initials: Z
authors.lastname: Nugent
authors.forename: Xuyan
authors.initials: X
authors.lastname: Sun
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Cooke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000150:complications*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D012307:Risk Factors; D018709:Statistics, Nonparametric