Treatment of secondary lower limb lymphedema after gynecologic cancer with complex decongestive therapy.

Secondary lower extremity lymphedema is a common complication of treatment for gynecological cancers. Conservative therapy plays an important role in the treatment of patients with secondary lower extremity lymphedema; in particular, complex decongestive therapy (CDT) has been recognized as an effective nonoperative technique for these patients. But CDT therapy for secondary lower extremity lymphedema remains a problem in China because this technique and its effectiveness have not achieved widespread use and popularity. Our goal was to assess effects of CDT in patients with secondary lower limb lymphedema after treatment for gynecological cancers. The retrospective study consisted of 60 patients who were treated with 20 sessions of CDT. Assessments included objective changes in limb circumference, degree of LE, imaging features, and incidence of erysipelas before and after CDT treatment. We found that CDT can effectively improve lymph stasis and promote backflow, and decrease circumference, interstitial fluid content, and incidence of erysipelas of lymphedematous lower limb. Our results demonstrate that CDT is an effective treatment method for patients with secondary lower limb lymphedema following treatment for gynecologic cancers. This technique should be more widely utilized and popularized in China to improve the quality of life of millions of patients with secondary lower limb lymphedema.

Effects of the Traditional Chinese Medical Prescription Linba Fang as a Treatment for Lymphedema.

Lymphedema can lead to a series of complicated and irreversible chronic pathological changes, including lymphatic fluid retention, infiltration of inflammatory cells, lipid deposition, and fibrosis of the surrounding tissues. Typically, compression physiotherapy is recommended for early lymphedema. However, the chronic fluid compartments will lead to fat deposition, skin fibrosis, and hyperkeratosis. Few treatment methods are available for patients with lymphedema. Previous studies have attempted to apply diuretics, diosmin, and sodium ß-aescinate to treatment for venous edema, but the curative effect was unsatisfactory. There is currently no established effective treatment for lymphedema. In this paper, we investigated the effects of the traditional Chinese medical prescription Linba Fang as a treatment for lymphedema using a mouse model. A lymphedema model was established in C57BL/6 mice through lymphatic ablation at the base of tails. Negative controls were administered with 0.5% sodium carboxymethyl cellulose solution by gavage twice daily, positive controls with aescuvenforte, and test mice with Linba Fang. Aescuvenforte and Linba Fang were dissolved in 0.5% sodium carboxymethyl cellulose solution to produce a homogeneous mixture. After treatment for 2-4 weeks, tail diameter and weight, inflammatory cytokine levels (IL-1, IL-6, and TNF-α), lipid deposition, and fibrosis were evaluated. The results showed that none of the mice died during the treatment with Linba Fang. The levels of tail swelling, inflammation, lipid deposition, and fibrosis in mice treated with Linba Fang were significantly decreased compared with negative and positive controls. Among mice treated with the same dose of Linba Fang, the levels of tail swelling, inflammation, lipid deposition, and fibrosis in mice treated for 4 weeks were significantly lower than those treated for 2 weeks. Among mice treated for the same duration of time, the levels of tail swelling, inflammation, lipid deposition, and fibrosis showed a decreasing tendency following increasing doses. Notably, the inflammation in tail tissues decreased to the similar level of normal group after treatment for 4 weeks using the high dose of Linba Fang. In conclusion, the traditional Chinese medical prescription Linba Fang could inhibit the pathological changes caused by lymphedema, including swelling, inflammation, lipid deposition, and fibrosis.

Lymphedema in China--experiences and prospects.

The history of prevention and treatment of lymphedema in China is long. Filarial lymphedema was the most common type of the disease in the past with 5 million patients countrywide in the 1950's. Great efforts have gone into controlling filariasis during the past 50 years, and China now has essentially eliminated filariasis. In contrast to the reduction in filarial lymphedema, there has been a trend of increase in secondary lymphedema cases after malignant tumor surgery. Although there are no precise figures on the incidence of lymphedema nationwide, physicians and therapists are in great clinical demand. Traditional Chinese medicine has shown effectiveness for prevention and treatment of inflammation and alleviating swelling. The combination with Western medicine may offer improved methods for lymphedema treatment.

The influence of local hyperthermia on lymphedema and lymphedematous skin of the human leg.

The influence of microwave and hot water immersion hyperthermia on lymphedema and lymphedematous skin of the leg in 12 patients was studied using circumference and volumetric measurements, immunohistochemistry and "quantitative" lymphoscintigraphy. Whereas heating was associated with a reduction in the girth and volume of the leg, lymph flow as assessed by lymphoscintigraphy was unchanged. Neither absorption of the radiolabeled nanocolloid from the injection site nor the rate of tracer accumulation in the inguinal lymph nodes was significantly altered by heat therapy. Histologically, the lymphedematous skin after heat treatment showed near resolution of perivascular cellular infiltration, disappearance of "lymph lakes" and dilatation of blood capillaries. Labeling of skin migrating immune cells with monoclonal antibodies confirmed subsidence of dermal cellular infiltration; nonetheless, there was nonspecific stimulation of resident epidermal immune cells, endothelial cells, macrophages, lymphocytes and keratinocytes by intense expression of class II and other antigens. There seemed to be a direct relationship between the subsidence of dermal inflammation and a decrease in leg edema. We suspect that subsidence of local inflammation in the lymphedematous limb with alteration in the extracellular protein matrix after regional heating accounts for the reduction in peripheral edema.

Use of tonometry to assess lower extremity lymphedema.

Tissue tonometry was used to assess the outcome of microwave hyperthermia in treatment of 9 patients with lower extremity lymphedema. After microwave treatment, tissue tonicity of the lymphedematous leg returned toward normal. This improvement correlated with a reduction of leg volume and circumference, decrease in "inflammation" in the edematous subcutaneous tissue and clinical episodes of cellulitis. Possible factors involved in this shift in tissue tonicity toward normal include mobilization of excess fluid and plasma proteins from the interstitium, reduction in microvascular cellular infiltrate and changes in the elastic and viscoelastic properties of matrix collagen, elastin and ground substance following hyperthermia.