title: Manipulative therapy of secondary lymphedema in the presence of locoregional tumors.
abstract: BACKGROUND
  Complete decongestive therapy (CDT), including manual lymphatic drainage (MLD) is a manipulative intervention of documented benefit to patients with lymphedema (LE). Although the role of CDT for LE is well described, to the authors' knowledge there are no data regarding its efficacy for patients with LE due to tumor masses in the draining anatomic bed. Traditionally, LE therapists are wary of providing therapy to such patients with 'malignant' LE for fear of exacerbating the underlying cancer, and that the obstruction will render therapy less effective. In the current study, the authors' experience providing CDT for such patients is discussed.
  
  
  METHODS
  Cancer survivors with LE were referred to therapists at 2 Atlanta-area clinics. CDT consists of treatment (Phase 1) and maintenance phases (Phase 2). During Phase 1, the patient undergoes manipulative therapy and bandaging daily until the LE reduction plateaus; at that point, Phase 2 (self-care) begins. At the beginning and end of Phase 1, LE is quantified and differences in girth volume calculated. The results for patients completing Phase 1 therapy for LE in the presence of locoregional masses were compared with results for patients with LE in the absence of such disease. Both volume reduction of the affected limb and number of treatments to plateau were analyzed.
  
  
  RESULTS
  Between January 2004, and March 2007, LE of 82 limbs in 72 patients was treated with CDT and Phase 1 was completed. The median number of treatments to plateau was 12 (range, 4-23 treatments); the median limb volume reduction was 22% (range, -23 to 164%). Nineteen limbs (16 patients) with associated chest wall/axillary or pelvic/inguinal tumors had nonsignificant difference in LE reduction (P = .75) in the presence of significantly more sessions to attain plateau (P = .0016) compared with 63 limbs in 56 patients without such masses.
  
  
  CONCLUSIONS
  Patients with LE may obtain relief with CDT regardless of whether they have locoregional disease contributing to their symptoms. However, it will likely take longer to achieve that effect. Manipulative therapy of LE should not be withheld because of persistent or recurrent disease in the draining anatomic bed.
authors: Radiation Oncology Department, Emory University School of Medicine, Atlanta, Georgia, USA.
authors: Ximena A
authors: XA
authors: Pinell
authors: Stephanie H
authors: SH
authors: Kirkpatrick
authors: Kennedy
authors: K
authors: Hawkins
authors: Tammy E
authors: TE
authors: Mondry
authors: Peter A S
authors: PA
authors: Johnstone
mesh_terms: D001458:Bandages; D004322:Drainage; D006801:Humans; D008209:Lymphedema / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D026201:Musculoskeletal Manipulations / Q000295:instrumentation / Q000379:methods*; D009369:Neoplasms / Q000150:complications*; D012648:Self Care / Q000379:methods; D017741:Survivors; D016896:Treatment Outcome