From the Capital Region Action Against Breast Cancer! (CRAAB!)
Lasers and Lymphedema
By Jessica Werder, M.P.H.Please note that while the studies listed below are both scientifically and methodologically sound, caution should be exercised in drawing conclusions from any one study. You can access this column from previous newsletters at craab.org.
Background and Recent Evidence:
The human lymphatic system is closely linked to our cardiovascular system and is sometimes known as part of the circulatory system. It consists of a network of lymph nodes that help to circulate a clear fluid called lymph. When a woman has a mastectomy or lumpectomy, standard protocol has had physicians removing nearby lymph nodes in an attempt to prevent cancer cells from spreading through the body by way of circulating lymph (called ALND, axillary lymph node dissection). When this is done, the flow of lymph can be disrupted, causing fluid buildup and swelling which is referred to as lymphedema (to note: lymphedema refers to any buildup of lymph, which may be caused by things other than surgery). Complications of lymphedema in breast cancer survivors can include swelling of the arm, pain, discomfort, limited mobility and even infection. Lymphedema is considered a serious quality of life issue among many breast cancer survivors. It persists as a major problem despite the fact that, as mentioned in the Recent Research column in Spring of 2011, for early stages ALND may have no benefit over other procedures (such as Sentinel Lymph Node Dissection) that have lower rates of lymphedema.
Recently, there has been much talk in the scientific community about the use of lasers to treat lymphedema. There are at least two very different approaches to using lasers that have come up in current reports. In February, a team of physicians published a case study in the journal OncoTargets and Therapy. In the single case reported, physicians used a fiber optic laser to conduct a surgical procedure, creating “tunnels” in the tissue of a 77-year old woman’s arm. The tunnels were created close to a network of existing lymphatic tissue in an attempt to help alleviate the accumulation of lymph. By applying manual pressure to the arm following the procedure (known as pressotherapy), it was possible to clear some of the lymphatic fluid into the tunnels, where it was eventually reabsorbed into the lymphatic systems as evidenced by the woman’s improved ability to move her fingers, wrist and elbow, following two laser treatments.
Another laser procedure that has recently been discussed is called Low Level Laser Therapy (LLLT). LLLT is not a surgical procedure, but rather a therapeutic approach in which a therapist places a device directly on the skin. The device emits a light believed to help with the flow of lymph. In November, 2006, a specific laser therapy unit, known as the Riancorp LTU-904, was approved by the FDA for use in treating post-mastectomy lymphedema,. The FDA’s approval rested on evidence from a clinical trial conducted with postmastectomy lymphedema patients in Australia; the trial suggested that half (52%) of participants receiving laser therapy experienced a decrease in fluid and one third (31%) experienced decreased arm swelling. Additional trials since the approval have shown similar results Currently, the New York University School of Medicine is recruiting for a U.S. clinical trial to examine the effects of LLLT for lymphedema in post-mastectomy lymphedema patients (http://clinicaltrials.gov/show/NCT01351376).
Interpretation and Implications:
Lymphedema is a serious complication from ALND and radiation for many breast cancer survivors. While attention to the problem’s sources (ALND and radiation) would decrease its incidence, any novel therapies that may help alleviate the symptoms of lymphedema should continue to be studied. The “tunnel” laser therapy mentioned above is a brand new procedure and needs significant study before application in patients. The initial LTU-904 approval by the FDA rested on the results of one clinical trial, though additional studies since have shown similar results. The clinical trial underway in the U.S. may lend additional information about the effectiveness of the device.
This article is an excerpt from the CRAAB! Newsletter Vol. 15, No. 3 • Summer/Fall 2013. Click here for more details and article references.