title: Intensive complete decongestive physiotherapy for cancer-related upper-limb lymphedema: 11 days achieved greater volume reduction than 4.
abstract: BACKGROUND
  Upper-limb lymphedema (ULL) occurs in 15-20% of women after breast-cancer treatment. Its intensive therapy relies on complete (complex) decongestive physiotherapy (CDP), whose duration is not well-established.
  
  
  OBJECTIVE
  Determine optimal intensive-phase CDP duration for lymphedema-volume reduction and factors predicting its success, with the hope of halving it from 11 to 4 days.
  
  
  METHODS
  All patients with ULL (08/2011-06/2012) after breast-cancer treatment referred to our Department of Lymphology in a rehabilitation facility for 11 days of CDP were eligible. Lymphedema volume was calculated using the truncated-cone formula. Volume reduction considered clinically relevant after 4 days was defined as ≥ 75% of the total reduction obtained after 11 days.
  
  
  RESULTS
  We included 129 women (median age: 64 (range: 42-88) years). Mean (sd) lymphedema volume was 907 (558) ml at CDP onset, decreased to 712 (428) ml after 4 days (vs. onset, P<.0001) and 606 (341) ml after 11 days (vs. 4, P<.0001), corresponding to 33% total lymphedema-volume reduction. For all patients, 4 days of CDP achieved 63% (sd 40%) of that total reduction, with ≥ 75% for 50 (39%) patients. Surgery-to-lymphedema-onset interval >2 years was the only factor significantly associated with 4 days achieving ≥ 75% of the total lymphedema-volume reduction.
  
  
  CONCLUSIONS
  Intensive phase CDP for 11 days obtained significantly more volume reduction of breast cancer-related ULL than 4.
authors.affiliation: Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares (lymphœdèmes primaires), Hôpital Cognacq-Jay, 75015 Paris, France. Electronic address: stephane.vignes@cognacq-jay.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Vignes
authors.forename: Marie
authors.initials: M
authors.lastname: Blanchard
authors.forename: Maria
authors.initials: M
authors.lastname: Arrault
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D058128:Compression Bandages; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000209:etiology / Q000628:therapy*; D008405:Massage; D010353:Patient Education as Topic; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D012307:Risk Factors; D017592:Skin Care; D013997:Time Factors
keywords: Breast; Cancer; Lymphedema; Treatment; Upper limb