Extracorporeal Shock Wave Therapy Combined with Complex Decongestive Therapy in Patients with Breast Cancer-Related Lymphedema: A Systemic Review and Meta-Analysis.

Yu Lin Tsai,Yu Chun Lee,Ya Chi Chuang,Yuan Yang Cheng,Ting Jie I

doi:10.3390/jcm10245970

Abstract

Breast cancer-related lymphedema (BCRL) is one of the most significant complications seen after surgery. Several studies demonstrated that extracorporeal shock wave therapy (ESWT), in addition to conventional complex decongestive therapy (CDT), had a positive effect on BCRL in various aspects. The systematic review and meta-analysis aim to explore the effectiveness of ESWT with or without CDT on BRCL patients. We searched PubMed, Embase, PEDro, Cochrane Library Databases, and Google Scholar for eligible articles and used PRISMA2020 for paper selection. Included studies were assessed by the PEDro score, Modified Jadad scale, STROBE assessment, and GRADE framework for the risk of bias evaluation. The primary outcomes were the volume of lymphedema and arm circumference. Secondary outcome measures were skin thickness, shoulder joint range of motion (ROM), and an impact on quality-of-life questionnaire. Studies were meta-analyzed with the mean difference (MD). Eight studies were included in the systemic review and four in the meta-analysis. In summary, we found that adjunctive ESWT may significantly improve the volume of lymphedema (MD = −76.44; 95% CI: −93.21, −59.68; p < 0.00001), skin thickness (MD = −1.65; 95% CI: −3.27, −0.02; p = 0.05), and shoulder ROM (MD = 7.03; 95% CI: 4.42, 9.64; p < 0.00001). The evidence level was very low upon GRADE appraisal. ESWT combined with CDT could significantly improve the volume of lymphedema, skin thickness, and shoulder ROM in patients with BCRL. There is not enough evidence to support the use of ESWT as a replacement for CDT. This study was registered with PROSPERO: CRD42021277110.

Highlights

The worldwide prevalence rate of breast cancer has increased continuously since 1990, whereas the overall mortality rate has decreased in most high-income countries [1,2]
In patients diagnosed with stage two or three lymphedema, local fibrotic change may alternate the effect of complex decongestive treatments (CDT) [9,13] and force patients to seek additional treatment
Publication titles were screened, and any duplicates taken from different databases were removed

Summary

Introduction

The worldwide prevalence rate of breast cancer has increased continuously since 1990, whereas the overall mortality rate has decreased in most high-income countries [1,2]. An increasing number of breast cancer survivors are suffering from complications brought on by surgery. Breast cancer-related lymphedema (BCRL) is one of the most significant complications seen after surgery. It could happen at any time post-operation with an overall incidence rate of 21.4% [3] but varies from 5% to 60% due to various diagnostic criteria [3,4]. Factors that can increase the risk of BCRL include the number of lymph nodes removed, axillary radiotherapy, a high body mass index, and cellulitis [5,6]. Non-invasive complex decongestive treatments (CDT) for BCRL include manual lymph drainage, intermittent pneumatic compression, compression bandage or garments, regular exercise, and skin care [9]. In patients diagnosed with stage two or three lymphedema, local fibrotic change may alternate the effect of CDT [9,13] and force patients to seek additional treatment

Objectives

Methods

Results