Low-Energy Extracorporeal Shockwave Therapy As A Therapeutic Option For Patients With A Secondary Late-Stage Fibro-Lymphedema After Breast Cancer Therapy: A Pilot Study

Background:Secondary lymphedema (LE) can occur after breast cancer (BC) therapy with axillary lymph node surgery and/or radiotherapy. Reported incidence varies around 20%. The aim of this study was to see whether low-energy extracorporeal shockwave therapy (ESWT) is a therapeutic option in end-stage secondary upper limb fibro-LE. Methods and Results:A pilot study was performed on 10 adult patients who presented with an end-stage LE after BC treatment. They were all treated with usual physical therapy and all had lymphatic surgery before. Eight sessions of ESWT were applied, 2600 shocks at 0.1 mJ/mm(2), 2/week during 4 weeks. Upper limb volume decreased nonsignificantly, from 3086.4 +/- 539.47 to 2909.1 +/- 471.60 mL. Mean circumference of the upper limb was significantly decreased from 32.3 +/- 3.01 to 31.4 +/- 2.71 cm at the height of the upper arm, from 29.1 +/- 2.89 to 28.1 +/- 2.71 cm at the height of the elbow, and from 27.5 +/- 4.08 to 26.8 +/- 3.75 cm at the height of the forearm. Subjective measurements by visual analog scale showed significant decrease in both hardness from 57.3 +/- 15.84 to 24.4 +/- 21.89 mm and subjective feeling of edema from 44.2 +/- 16.90 to 23.2 +/- 21.16 mm. No adverse features were reported. Conclusion:We added some evidence that low-energy ESWT is well supported and has additional benefits also in longstanding fibro-lipo-LE on swelling of the arm leading to more subjective comfort for the patients.