Current Treatments for Breast Cancer-Related Lymphoedema: A Systematic Review

  • Li, Lun (Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University) ;
  • Yuan, Liqin (Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University) ;
  • Chen, Xianyu (Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University) ;
  • Wang, Quan (Department of Gastrointestinal Surgery, Xijing Hospital of Digestive Diseases, Xijing Hospital, Four Military Medical University) ;
  • Tian, Jinhui (Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University) ;
  • Yang, Kehu (Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University) ;
  • Zhou, Enxiang (Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University)
  • Published : 2016.11.01


Background and objective: Breast cancer-related lymphoedema (BCRL) is a disabling complication with long term impact on quality on life after breast cancer treatment. Its management remains a major challenge for patients and health care professionals; the goal of this overview was to summarize effects of different treatment strategies for patients with BCRL. Methods: A thorough search was undertaken to allow a systematic review or meta-analysis of treatments for BCRL. Two investigators independently selected studies and abstracted the data. Results: Combined physical therapy (CPT) with different combinations of surgery, oral pharmaceuticals, low-level laser therapy, weight reduction, mesenchymal stem cell therapy, kinesio tex taping, and acupuncture might be effective in reducing lymphoedema, but exercise demonstrated no obvious benefit. The results of direct comparisons showed CPT might be more effective than standard physiotherapy (ST). Manual lymphatic drainage (MLD) may not offer additional benefits to ST for swelling reduction, but could facilitate compression bandaging. MLD seemed to have similar effects with self-administered simple lymphatic drainage (SLD) or using an intermittent pneumatic compression pump (IPC). IPC might also not be associated with additional effectiveness for CPT. Efficacy of stem cell therapy vs. compression sleeve or CPT, as well as the effects of daflon and coumarin could not be established. Conclusion: Although many treatments for BCRL might reduce lymphoedema volume, their effects were not well established. The quality of many of the original studies in the included reviews was not optimal, so that in future randomized control trials are a high priority.


  1. Alem M, Gurgel MS (2008). Acupuncture in the rehabilitation of women after breast cancer surgery-a case series. Acupunct Med, 26, 87-93.
  2. Biscaia Raposo Mourao e Lima MT, Mouro e Lima JG, Carvalho de Andrade MF, et al (2014). Low-level laser therapy in secondary lymphedema after breast cancer: systematic review. Lasers Med Sci, 29, 1289-95.
  3. Casley-Smith JR, Morgan RG, Piller NB (1993). Treatment of lymphedema of the arms and legs with 5,6-benzo-[alpha]-pyrone. N Engl J Med, 329, 1158-63.
  4. Cassileth BR, Van Zee KJ, Chan Y, et al (2011). A safety and efficacy pilot study of acupuncture for the treatment of chronic lymphoedema. Acupunct Med, 29, 170-2.
  5. Chan DNS, Lui LYY, So WKW (2010). Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: systematic review. J Adv Nurs, 66, 1902-14.
  6. Cheema BS, Kilbreath SL, Fahey PP, et al (2014). Safety and efficacy of progressive resistance training in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat, 148, 249-68.
  7. Cheifetz O, Haley L, Breast Canc A (2010). Management of secondary lymphedema related to breast cancer. Can Fam Physician, 56, 1277-84.
  8. Cluzan RV, Alliot F, Ghabboun S, et al (1996). Treatment of secondary lymphedema of the upper limb with CYCLO 3 FORT. Lymphology, 29, 29-35.
  9. Cluzan RV, Pecking AP, Mathiex-Fortunet H, et al (2004). Efficacy of BN165 (Ginkor Fort) in breast cancer related upper limb lymphedema: a preliminary study. Lymphology, 37, 47-52.
  10. Devoogdt N, Van Kampen M, Geraerts I, et al (2010). Different physical treatment modalities for lymphoedema developing after axillary lymph node dissection for breast cancer: A review. Eur J Obstet Gynecol Reprod Biol, 149, 3-9.
  11. Didem K, Ufuk YS, Serdar S, et al (2005). The comparison of two different physiotherapy methods in treatment of lymphedema after breast surgery. Breast Cancer Res Treat, 93, 49-54.
  12. DiSipio T, Rye S, Newman B, et al (2013). Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol, 14, 500-15.
  13. Dos Santos S, Hill N, Morgan A, et al (2010). Acupuncture for treating common side effects associated with breast cancer treatment: A systematic review. Med Acupunct, 22, 81-97.
  14. Ezzo J, Manheimer E, McNeely ML, et al (2015). Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev, 5, CD003475.
  15. Foldi E, Foldi M, Clodius L (1989). The lymphedema chaos: a lancet. Ann Plast Surg, 22, 505-15.
  16. Finnane A, Janda M, Hayes SC (2015). Review of the Evidence of Lymphedema Treatment Effect. Am J Phys Med Rehabil, 94, 483-98.
  17. Fu MR (2014). Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management. World J Clin Oncol, 5, 241-7.
  18. Fu MR, Ridner SH, Hu SH, et al (2013). Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011. Psychooncology, 22, 1466-84.
  19. Garcia MK, McQuade J, Lee R, et al (2014). Acupuncture for Symptom Management in Cancer Care: an Update. Curr Oncol Rep, 16, 418.
  20. Goker M, Devoogdt N, Van de Putte G, et al (2013). Systematic review of breast cancer related lymphoedema: making a balanced decision to perform an axillary clearance. Facts Views Vis Obgyn, 5, 106-15.
  21. Guyatt G, Oxman AD, Akl E, et al (2010). GRADE guidelines 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol, 64, 383-94.
  22. Hidding JT, Beurskens CHG, van der Wees PJ, et al (2014). Treatment Related Impairments in Arm and Shoulder in Patients with Breast Cancer: A Systematic Review. Plos One, 9.
  23. Higgins JPT, S. G Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. Available from www. Cochrane-
  24. Hou C, Wu X, Jin X (2008). Autologous bone marrow stromal cells transplantation for the treatment of secondary arm lymphedema: a prospective controlled study in patients with breast cancer related lymphedema. Jpn J Clin Oncol, 38, 670-4.
  25. Huang TW, Tseng SH, Lin CC, et al (2013). Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials. World J Surg Oncol, 11, 15.
  26. Karki A, Anttila H, Tasmuth T, et al (2009). Lymphoedema therapy in breast cancer patients: a systematic review on effectiveness and a survey of current practices and costs in Finland. Acta Oncol, 48, 850-9.
  27. Kwan ML, Cohn JC, Armer JM, et al (2011). Exercise in patients with lymphedema: a systematic review of the contemporary literature. J Cancer Surviv, 5, 320-36.
  28. Lasinski BB, Thrift KM, Squire D, et al (2012). A Systematic Review of the Evidence for Complete Decongestive Therapy in the Treatment of Lymphedema From 2004 to 2011. PM R, 4, 580-601.
  29. Leung N, Furniss D, Giele H (2015). Modern surgical management of breast cancer therapy related upper limb and breast lymphoedema. Maturitas, 80, 384-90.
  30. Li L, Tian J, Tian H, et al (2012). Quality and transparency of overviews of systematic reviews. J Evid Based Med, 5, 166-73.
  31. Llavero-Valero M, Guillen-Grima F, Zafon C, et al (2016). The placebo effect in thyroid cancer: a meta-analysis. Eur J Endocrinol, 174, 465-72.
  32. Loprinzi CL, Kugler JW, Sloan JA, et al (1999). Lack of effect of coumarin in women with lymphedema after treatment for breast cancer. N Engl J Med, 340, 346-50.
  33. Maldonado GE, Perez CA, Covarrubias EE, et al (2011). Autologous stem cells for the treatment of post-mastectomy lymphedema: a pilot study. Cytotherapy, 13, 1249-55.
  34. Monteiro SE, Resende LV, Felicissimo MF, et al (2014). Treatment of upper limb lymphedema with low-level laser: a systematic review revisao sistematica. Fisioterapia em Movimento, 27, 663-74.
  35. Morris D, Jones D, Ryan H, et al (2013). The clinical effects of Kinesio (R) Tex taping: A systematic review. Physiother Theory Pract, 29, 259-70.
  36. Moseley AL, Carati CJ, Piller NB (2007). A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. Ann Oncol, 18, 639-46.
  37. MT EL, JG EL, Andrade MF, et al (2014). Low-level laser therapy in secondary lymphedema after breast cancer: systematic review. Lasers Med Sci, 29, 1289-95.
  38. Nasser M, Fedorowicz Z (2011). Grading the quality of evidence and strength of recommendations: the GRADE approach to improving dental clinical guidelines. J Appl Oral Sci, 19, 1.
  39. Nuesch E, Trelle S, Reichenbach S, et al (2010). Small study effects in meta-analyses of osteoarthritis trials: meta-epidemiological study. BMJ, 341, c3515.
  40. Omar MTA, Shaheen AAM, Zafar H (2012). A systematic review of the effect of low-level laser therapy in the management of breast cancer-related lymphedema. Support Care Cancer, 20, 2977-84.
  41. Oremus M, Dayes I, Walker K, et al (2012). Systematic review: conservative treatments for secondary lymphedema. BMC Cancer, 12, 1-15.
  42. Pan YQ, Yang KH, Wang YL, et al (2014). Massage interventions and treatment-related side effects of breast cancer: a systematic review and meta-analysis. Int J Clin Oncol, 19, 829-41.
  43. Paramanandam VS, Roberts D (2014). Weight training is not harmful for women with breast cancer-related lymphoedema: a systematic review. J Physiother, 60, 136-43.
  44. Pecking AP, Fevrier B, Wargon C, et al (1997). Efficacy of Daflon 500 mg in the treatment of lymphedema (secondary to conventional therapy of breast cancer). Angiology, 48, 93-8.
  45. Penha TRL, Ijsbrandy C, Hendrix NAM, et al (2013). Microsurgical techniques for the treatment of breast cancer-related Lymphedema: a systematic review. J Reconstr Microsurg, 29, 99-106.
  46. Pieper D, Buechter RB, Li L, et al (2015). Systematic review found AMSTAR, but not R (evised)-AMSTAR, to have good measurement properties. J Clin Epidemiol, 68, 574-83.
  47. Poage EG, Rodrick JR, Wanchai A, et al (2015). Exploring the usefulness of botanicals as an adjunctive treatment for lymphedema: a systematic search and review. PM R, 7, 296-310.
  48. Ridner SH, Fu MR, Wanchai A, et al (2012). Self-management of lymphedema a systematic review of the literature from 2004 to 2011. Hu Li Yan Jiu, 61, 291-9.
  49. Shao Y, Qi K, Zhou QH, et al (2014). Intermittent pneumatic compression pump for breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials. Oncol Res Treat, 37, 170-4.
  50. Shaw C, Mortimer P, Judd PA (2007). A randomized controlled trial of weight reduction as a treatment for breast cancer-related lymphedema. Cancer, 110, 1868-74.
  51. Singh B, Disipio T, Peake J, et al (2016). Systematic review and meta-analysis of the effects of exercise for those with cancer-related lymphedema. Arch Phys Med Rehabil, 97, 302-15.
  52. Smoot B, Chiavola-Larson L, Lee J, et al (2015). Effect of low-level laser therapy on pain and swelling in women with breast cancer-related lymphedema: a systematic review and meta-analysis. J Cancer Surviv, 9, 287-304.
  53. Swedborg I, Norrefalk JR, Piller NB, et al (1993). Lymphoedema post-mastectomy: is elevation alone an effective treatment? Scand J Rehabil Med, 25, 79-82.
  54. Toyserkani NM, Christensen ML, Sheikh SP, et al (2015). Stem cells show promising results for lymphoedema treatment - A literature review. J Plast Surg Hand Surg, 49, 65-71.
  55. Zhang Z, Xu X, Ni H (2013). Small studies may overestimate the effect sizes in critical care meta-analyses: a meta-epidemiological study. Crit Care, 17, R2.
  56. Zhu YQ, Xie YH, Liu FH, et al (2014). Systemic analysis on risk factors for breast cancer related lymphedema. Asian Pac J Cancer Prev, 15, 6535-41.