Manual Drainage for Lymphedema Investigated in First-Ever RCT

Zosia Chustecka

December 11, 2010

December 11, 2010 (San Antonio, Texas) — Manual lymph drainage (MLD) in the form of massage was not effective in preventing arm lymphedema in patients with breast cancer who had undergone axillary lymph node dissection.

The results come from a randomized clinical trial in 160 patients with breast cancer, reported here today at the 33rd Annual San Antonio Breast Cancer Symposium.

"This is a very nice study," commented session moderator Hiram Cody, MD, from the Memorial Sloan-Kettering Cancer Center in New York City. "This has been a data-free zone, and this [study] is a very nice addition," he added.

Nele Devoogdt

The results were presented by Nele Devoogdt, from University Hospitals Leuven, in Belgium, who undertook the study as part of her doctoral thesis. She was the recipient of a scholarship awarded by the American Association for Cancer Research Translational Research Scholars and funded by Susan G. Komen for the Cure.

Massage to Increase Lymph Drainage

MLD is a kind of massage where the skin is stretched, Ms. Devoogdt explained. The theory is that it would help to prevent the development of lymphedema by increasing the resorption of lymph, increasing lymph transport, and creating collateral pathways to aid in lymph drainage.

However, she pointed out that its effectiveness in preventing lymphedema has never been tested in a randomized controlled clinical trial.

So this is what her group set out to investigate. They compared a program consisting of information and exercises therapy, with and without the addition of MDL, in a series of 160 consecutive patients with breast cancer who underwent unilateral axillary node dissection. The program began 5 weeks after surgery.

In this trial, MDL was administered 1 to 3 times per week, with a median total of 34 sessions.

Patients had their arm volume measured at regular intervals with a volumeter. Lymphedema was defined as an increase of 2 cm or more at 2 adjacent points along the arm compared with presurgery measurements.

The results show no statistical difference between the 2 groups, and in fact, they numerically appeared to be better in the group without MLD.


  Proportion of Women Who Developed Lymphedema
Time After Surgery With MLD Without MLD
3 months 7% 5%
6 months 12% 10%
12 months 23% 18%

Time to develop lymphedema was also comparable in the 2 groups, as were the scores on mental and physical quality-of-life questionnaires. In addition, the patients who did develop lymphedema in both groups had comparable functioning problems.

"[MLD] applied after axillary lymph node dissection for breast cancer is not effective to prevent arm lymphedema at short-term," the researchers concluded.

The authors have disclosed no relevant financial relationships.

33rd Annual San Antonio Breast Cancer Symposium: Abstract S5-3. Presented December 11, 2010.


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