Соmplex Medical Rehabilitation for Cancer-related Lower Limbs Lymphedema: a Prospective Comparative Randomized Study of 60 Patients

Abstract

INTRODUCTION. The management of patients with secondary lymphedema of the lower extremities associated with radical treatment of pelvic cancer (Cancer Related Lymphedema) is extremely problematic due to persistent impairment of the draining function of regional lymph nodes due to intraoperative dissection and subsequent radiation therapy. AIM. To compare the effectiveness of complex medical rehabilitation using the kinesio taping method and innovative non-stretchable compression bandages in patients with secondary lymphedema of the lower extremities associated with radical treatment of pelvic cancer. MATERIAL AND METHODS. The study involved 60 patients with stages I-III Cancer Related Lymphedema (according to the classification of Savchenko T.V., Pokrovsky A.V., 2004) who underwent radical treatment for various forms of pelvic cancer (gynecological cancer in women and prostate cancer in men), randomized into 2 groups (30 people each). A comprehensive rehabilitation was carried out in the main group (n=30), including sequential manual lymphatic drainage, skin care, kinesio taping, therapeutic gymnastics in the gym; Adjustable Non-stretchable Compression Bandages (circaid juxtafit, Germany). Meanwhile, a Complex Decongestive Therapy was performed in the comparison group (n=30), which is considered as the gold standard of conservative treatment of lymphedema of the lower extremities, including manual lymphatic drainage, skin care, Multi-layered limb banding using Inelastic compression Bandages. In order to evaluate the anti-edematous effect the dynamics of the circumferences of the lower extremities, waist circumference and hip circumference, the Ankle Range of Motion were examined using goniometry, bio-impedancemetry. Laser Doppler Flowmetry was used to evaluate microcirculatory parameters. RESULTS AND DISCUSSION. There was a decrease in swelling and thickening of the skin in the thigh, a decrease the external genitalia edema in patients with Cancer Related Lymphedema in both groups after a course of rehabilitation. There was a regression of swelling of the feet and lower legs in patients of both groups (p<0.05) after treatment, which was confirmed by a decrease in the circumferences of the lower limbs. There was an increase in the Ankle Range of Motion (dorsiflexion) from 17.50±1.26° to 19.25±1.52° (p<0.05) in the main group and from 17.90±1.44° to 18.59±1.10° (p<0.05) in the comparison group. According to the bio-impedancemetry data, there was a decrease in the extracellular fluid content both in the main group and the comparison group by 2.64% and 2.83%, (p<0.05) respectively. There was also a comparable decrease in the total fluid content by 2.67% in the main group and 1.90% (p<0.05) in the comparison group. There were a decrease in body weight by 2.49% and 1.52% (p<0.001), a decrease in fat mass by 2.62% and 4.01% (p<0.05) in both groups respectively after the course of treatment. According to the Laser Doppler Flowmetry data, there were an improvement in the indicators of myogenic tone of arterioles and secretory activity of the endothelium, as well as elimination of venular congestion in patients of both groups (p<0.05). CONCLUSION. Regression of edema in Cancer Related Lymphedema can be achieved as a result of the use of manual lymphatic drainage which stimulates the outflow of lymph through lymphatic watersheds into adjacent lymphatic territories with intact regional lymph nodes, which was achieved in both groups. The lymphatic drainage effect of manual lymphatic drainage was supported by the daily compression profile of bandages (Multi-layered Inelastic Bandages and Adjustable Non-stretchable Compression Bandages) in patients of both groups. Our study showed that the use of kinesio tapes leveled the difference in compression of approximately 10-15 mmHg between the bandages used (50 mmHg/~60 mmHg).

Laser Therapy in Comprehensive Treatment of Patients with Lymphedema of Lower Limbs

“…Основная направленность лечения вторичной и первичной лимфедемы -консервативная терапия . Назначаются: гимнастика в воде с положительным эффектом, особенно в краткосрочной перспективе [18], иглоукалывание на здоровой конечности при лимфедеме верхней конечности [19], применение ортопедических стелек, восстановление подвижности стопы и голеностопного сустава [20] . В комплексное лечение необходимо включать следующие методы: механические (лечебная гимнастика, массаж, компрессионная терапия, контроль массы тела), физические (амплипульс, электрофорез, электростимуляция, пневмокомпрессия, баротерапия, ультрафиолетовое облучение крови) и фармакологические (препараты, способствующие улучшению лимфотока, нормализации сократительной активности лимфатических сосудов, профилактике рецидивов рожистого воспаления, улучшению венозного оттока, коррекции воспалительных и трофических изменений тканей) [9], а также последовательный ручной лимфодренаж, кинезиотейпирование, лечебную гимнастику в тренажерном зале [20] .…”