Horse chestnut seed extract for the treatment of arm lymphedema

Abstract

8095 Background: Lymphedema of the arm occurs frequently as a consequence of surgical and radiation damage to the major lymphatics during lymph node dissection (LND) and adjuvant treatment of breast cancer. Usual lymphedema treatments are massage, compression sleeves and wraps; there are no drug treatments currently available in the USA. This is an interim report of our use of Horse chestnut seed extract (HCSE) for the treatment of arm lymphedema in breast cancer survivors. HCSE is widely used in Europe for venous and lymphatic disorders, and is postulated to act by decreasing capillary and interstitial permeability. Methods: In this double-blind, randomized, and placebo-controlled study, eligible subjects with stable arm lymphedema receive placebo or HCSE (50mg escins) twice daily PO for three months, followed by a 1 month washout. Eligible subjects have affected : unaffected arm edema ratios of ≥ 1.1 to 1 by bioelectric impedance, and significant response was empirically set as a 15% decrease in arm ratios. Arm edema is measured concurrently with serial tape measurements, water displacement, and bioelectric impedance. Subjective assessments include the FACT-B QOL instrument and a 16-item experimental lymphedema questionnaire. Results: 25 subjects (of 68 sought) are evaluable at 3 months. 24 patients are at intermediate assessment points and accrual continues. One patient developed progression of known breast cancer metastases; one developed minor, reversible dizziness and tolerated 50% dose reduction. There are no statistically significant differences in the amount of lymphedema at 3 months by any of the measurement techniques. Small changes in arm volume are not reflected by correlative changes in the scores of the QOL instruments. Conclusions: HCSE at doses commonly used for treating CVI or varicose veins is well tolerated in breast cancer survivors with lymphedema. This interim analysis does not demonstrate significant objective or subjective benefit of HCSE in reducing arm lymphedema. QOL questionnaires need improvement to identify issues that more specifically reflect the impact of lymphedema. Funded by the Susan G. Komen Breast Cancer Research Foundation (BCTR 0100506). No significant financial relationships to disclose.