Laser Treatment Helpful in Postmastectomy Lymphedema

Laurie Barclay, MD

September 16, 2003

Sept. 16, 2003 — Two cycles of low-level laser treatment (LLLT), but not one, are effective in reducing the volume, tissue hardness, and extracellular fluid associated with postmastectomy lymphedema, according to the results of the first double-blind, placebo-controlled trial on the topic, published in the Sept. 15 issue of Cancer. However, range of motion was not improved.

"Recent reports indicate an efficacy for LLLT in the treatment of lymphedema, with both practitioners and clients reporting remarkably rapid improvement of lymphedema, often within hours of irradiation," write Colin J. Carati, PhD, from Flinders University in Adelaide, South Australia, and colleagues. "We reasoned that the laser might reduce fibrosis and activate surviving lymphatic drainage pathways, stimulate the growth of new pathways, and/or stimulate a localized lymphocyte response that may assist in resolving the lymphedema."

In this single crossover trial, 61 patients with postmastectomy lymphedema were randomized to receive placebo, one cycle of LLLT, or two cycles of LLLT to the axillary region of their affected arm.

Although there was no significant improvement noted immediately after any of the treatments, the mean affected limb volume decreased significantly at one month or three months of follow-up after two cycles of active laser treatment. Nearly one third of subjects had a clinically significant reduction in volume by more than 200 mL approximately two to three months after two cycles of treatment. Placebo treatment or one cycle of LLLT did not significantly affect limb volume.

Three months after two cycles of LLLT, the extracellular fluid index of the affected and unaffected arms and torso decreased significantly, and there was significant softening of tissues in the affected upper arm. However, treatment did not appear to improve range of motion.

"Further improvements in the use of LLLT, in the treatment of a range of conditions, rest on a better understanding of its mode of action," the authors write. "The mechanism(s) of action of LLLT in tissues remains elusive, and most likely is complex, involving many aspects of tissue physiology."

The Australian government funded this study through an AUSIndustry grant to RIAN Corporation, the manufacturer of the laser used in this study, and Flinders University. Dr. Carati occasionally acts as a consultant for Rian Corporation.

Cancer. 2003;98:1114-1122

Reviewed by Gary D. Vogin, MD

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