title: Factors influencing breast cancer-related lymphedema volume after intensive decongestive physiotherapy.
abstract: BACKGROUND
  Lymphedema treatment is based on an intensive decongestive physiotherapy phase of volume reduction followed by a long-term maintenance phase. Factors influencing the morbid lymphedema volume increase during maintenance were analyzed.
  
  
  METHODS
  Among 867 consecutive women recruited and followed in a single lymphology unit, 682 were analyzed. The other 185 were not analyzed because of an initial lymphedema volume <250 ml, <20% lymphedema volume decrease during the intensive phase, or they were lost to follow-up. Lymphedema volume was recorded prior to and at the end of intensive phase, and at each follow-up visit. During follow-up, treatment failure was defined as a lymphedema volume increase of ≥50% of the total reduction obtained during the intensive phase.
  
  
  RESULTS
  Median lymphedema volume was 936 ml before and 335 ml after intensive decongestive physiotherapy (P < 0.0001). Median follow-up was 28 months. During the maintenance phase, the risk of treatment failure at 1, 2, and 4 years was estimated to be 38.1%, 53.1%, and 64.8%, respectively. Wearing an elastic sleeve during the day and an overnight multilayer low-stretch bandage (median, four nights per week; interquartile range, 2-6) significantly decreased the risk of treatment failure [hazard ratio, 0.53, (0.34-0.82), P = 0.004], whereas manual lymph drainage adjunction to those therapeutic components did not. The risk of treatment failure was also associated with weight and body mass index at inclusion.
  
  
  CONCLUSIONS
  Risk of maintenance-therapy failure after intensive decongestive physiotherapy was associated with patients characteristics (younger age, higher weight, and body mass index), while elastic sleeve and bandage were associated with better maintenance results. Paradoxical effect of manual lymph drainage is likely to be related to indication bias.
authors.affiliation: Department of Lymphology, Hôpital Cognacq-Jay, 15, rue Eugène Millon, 75015, Paris, France. stephane.vignes@hopital-cognacq-jay.fr
authors.forename: Stéphane
authors.initials: S
authors.lastname: Vignes
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
authors.forename: Maria
authors.initials: M
authors.lastname: Arrault
authors.forename: Alain
authors.initials: A
authors.lastname: Dupuy
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000150:complications* / Q000523:psychology / Q000628:therapy; D016001:Confidence Intervals; D004322:Drainage; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008209:Lymphedema / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D011446:Prospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D053828:Stockings, Compression