Effect of various photobiomodulation regimens on breast cancer-related lymphedema: A systematic review and meta-analysis.

Breast cancer-related lymphedema (BCRL) is common among patients who have completed their cancer treatment. Although low-level laser therapy (LLLT) has been explored as a treatment option for BCRL, we could not find a regimen that is more effective than others. This meta-analysis aimed to organize existing research and determine the optimal combination of LLLT parameters for BCRL treatment. Studies were collected from four online databases: Embase, Ovid Medline, Cochrane, and Cinahl. The collected studies were reviewed by two of the authors. We focused on the aspects of the treatment area, treatment regimen, and total treatment sessions across the included studies. The comparisons between LLLT and non-LLLT were performed through a meta-analysis. Post-treatment QOL was significantly better in the axillary group. The group treated "three times/week with a laser density of 1.5-2 J/cm2" had significantly better outcomes in terms of swelling reduction, both immediately post-treatment and at 1-3 months follow-ups. The group with > 15 treatment sessions had significantly better post-treatment outcomes regarding reduced swelling and improved grip strength. According to these results, LLLT can relieve the symptoms of BCRL by reducing limb swelling and improving QOL. Further exploration found that a treatment approach targeting the axilla, combined with an increased treatment frequency, appropriate laser density, and extended treatment course, yielded better outcomes. However, further rigorous, large-scale studies, including long-term follow-up, are needed to substantiate this regimen.

[State of art of photobiomodulation in the management of radiotherapy adverse events: Indications and level of evidence]. / État de l'art de la photobiomodulation dans la prise en charge des effets secondaires de la radiothérapie : indications et niveaux de preuve.

PURPOSE: To evaluate the current and potential indications of photobiomodulation (PBM) and their level of evidence in the prevention or management of radiation therapy-related side effects. MATERIALS AND METHODS: The Embase, Medline/PubMed, Cochrane, EBSCO, Scopus, and LILACS databases were systematically reviewed to include and analyze publications of clinical studies that have assessed PBM in the prevention or management of radiotherapy-related side effects. The keywords used were "photobiomodulation"; "low level laser therapy"; "acute oral mucositis"; "acute dysphagia"; "acute radiation dermatitis"; "lymphedema"; "xerostomia"; "hyposalivation"; "trismus"; "bone necrosis"; "osteoradionecrosis"; and "radiation induced fibrosis". Prospective studies were included, whereas retrospective cohorts and non-original articles were excluded from the analysis. RESULTS: PBM in the red or infrared spectrum has demonstrated efficacy in randomized controlled trials in the prevention and management of radiotherapy-related side effects, especially acute oral mucositis, acute radiation dermatitis, and upper extremity lymphedema. The level of evidence associated with PBM was heterogeneous, but overall was still moderate. The main shortcomings were the diversity and lack of detail in treatment protocols, which could have compromised efficiency and reproducibility of PBM results. CONCLUSION: The published data suggest that PBM may be considered as a full-fledged supportive care for patients treated with radiotherapy, or at least in the setting of a therapeutic clinical trial. However, until strong evidence has been published on its long-term safety, the use of PBM should be considered with caution, specifically when applied near areas with proven or potential tumors. The patient should be informed of the theoretical benefits and risks of PBM in order to obtain his informed consent before treatment.

Tumor safety and side effects of photobiomodulation therapy used for prevention and management of cancer treatment toxicities. A systematic review.

Photobiomodulation therapy (PBMT), also known as low-level laser therapy (LLLT), has been increasingly used for the treatment of toxicities related to cancer treatment. One of the challenges for the universal acceptance of PBMT use in cancer patients is whether or not there is a potential for the light to stimulate the growth of residual malignant cells that evaded oncologic treatment, increasing the risk for tumor recurrences and development of a second primary tumor. Current science suggests promising effects of PBMT in the prevention and treatment of breast cancer-related lymphedema and oral mucositis, among other cancer treatment toxicities. Nevertheless, this seems to be the first systematic review to analyze the safety of the use of PBMT for the management of cancer-related toxicities. Scopus, MEDLINE/PubMed, and Embase were searched electronically. A total of 27 articles met the search criteria. Selected studies included the use of PBMT for prevention and treatment of oral mucositis, lymphedema, radiodermatitis, and peripheral neuropathy. Most studies showed that no side effects were observed with the use of PBMT. The results of this systematic review, based on current literature, suggest that the use of PBMT in the prevention and management of cancer treatment toxicities does not lead to the development of tumor safety issues.

Photobiomodulation or low-level laser therapy in the management of cancer therapy-induced mucositis, dermatitis and lymphedema.

PURPOSE OR REVIEW: There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT) also known as PhotoBioModulation (PBM) when used for the prevention and/or treatment of oral mucositis in patients undergoing radiotherapy for head and neck cancer, or high-dose chemotherapy regimens. This review aims at giving the state of the art of this technique in this indication. RECENT FINDINGS: Recent advances in LLLT/PBM technology, together with a better understanding of mechanisms involved and dosimetric parameters may lead to the management of a broader range of complications associated with cancer treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. SUMMARY: The article discusses LLLT/PBM mechanisms of action, dosimetry, and safety, and aims to identify some cancer treatment side-effects for which LLLT/PBM may prove to be effective (oral mucositis, radiation dermatitis, lymphedema). In addition, LLLT/PBM parameters for each of these complications are suggested and future research directions are discussed.

Efficacy and safety of far infrared radiation in lymphedema treatment: clinical evaluation and laboratory analysis.

Swelling is the most common symptom of extremities lymphedema. Clinical evaluation and laboratory analysis were conducted after far infrared radiation (FIR) treatment on the main four components of lymphedema: fluid, fat, protein, and hyaluronan. Far infrared radiation is a kind of hyperthermia therapy with several and additional benefits as well as promoting microcirculation flow and improving collateral lymph circumfluence. Although FIR therapy has been applied for several years on thousands of lymphedema patients, there are still few studies that have reported the biological effects of FIR on lymphatic tissue. In this research, we investigate the effects of far infrared rays on the major components of lymphatic tissue. Then, we explore the effectiveness and safety of FIR as a promising treatment modality of lymphedema. A total of 32 patients affected by lymphedema in stage II and III were treated between January 2015 and January 2016 at our department. After therapy, a significant decrease of limb circumference measurements was noted and improving of quality of life was registered. Laboratory examination showed the treatment can also decrease the deposition of fluid, fat, hyaluronan, and protein, improving the swelling condition. We believe FIR treatment could be considered as both an alternative monotherapy and a useful adjunctive to the conservative or surgical lymphedema procedures. Furthermore, the real and significant biological effects of FIR represent possible future applications in wide range of the medical field.

Photobiomodulation therapy in breast cancer-related lymphedema: a randomized placebo-controlled trial.

BACKGROUND: The aim of our study was to examine the effects of photobiomodulation therapy (PBMT) in the treatment of breast cancer-related lymphedema using a compactly designed treatment regime consisting of eight therapy sessions in combination with a cluster laser device covering a total area size of 78.54 cm² over the axillary. METHODS: Forty patients with unilateral lymphedema were enrolled in this double-blind, placebo-controlled trial in order to evaluate effects of PBMT on lymphedema-related pain, quality of life, grip strength and limb volume difference. Subjects received irradiation for ten minutes per session using a cluster laser covering a beam area of 78.54 cm². The applied energy was 384 Joules resulting in an energy density of 4.89 J/cm². RESULTS: Post-treatment, a 50% reduction in median pain scores and an increase in mean quality of life were observed. Mean grip strength was persistently higher after eight sessions of PBMT compared with pretreatment; however, no statistically significant intergroup differences (P > 0.05) were found over the time course. CONCLUSION: PBMT using a compactly designed treatment regime in combination with a cluster laser device did not significantly improve quality of life, pain scores, grip strength and limb volume over the time course.

Anti-inflammatory and lymphangiogenetic effects of low-level laser therapy on lymphedema in an experimental mouse tail model.

The aim of the present study was to investigate the therapeutic mechanism of low-level laser therapy (LLLT) in the mouse tail lymphedema model. Six-week-old female mice were classified into the laser treatment group, sham treatment group, and surgical control group (10 mice per group). LLLT was administered daily for 10 min from the surgical day to 11 days (12 times). Macrophage activation and lymphatic vessel regeneration were evaluated through immunohistochemical staining with anti-F4/80 and anti-LYVE-1 antibodies, respectively, at 12 days post-procedure. Quantitative real-time polymerase chain reaction (qPCR) was performed to measure messenger RNA (mRNA) expression of vascular endothelial growth factor A, B, C, R1, R2, and R3 (VEGF-A, VEGF-B, VEGF-C, VEGFR1, VEGFR2, and VEGFR3) at 12 days post-procedure. Student's t and one-way ANOVA tests were performed for statistical analyses. Significance was defined as p < 0.05. The thickness of the tail rapidly increased until 6 days in the laser and sham groups. The mice in the laser group showed a significantly decreased thickness compared with the sham group at 10 and 12 days. Immunohistochemistry assay revealed that LLLT reduced inflammation and induced new lymphatic vessel growth. qPCR showed that expressions of VEGFR3 were (p = 0.002) increased in the laser group. These results suggest that LLLT has anti-inflammatory and lymphangiogenetic effects for the management of lymphedema.

Actualización del cáncer de mama en atención primaria (IV/V) / Update of breast cancer in primary care (IV/V)

El cáncer de mama es una enfermedad prevalente con implicaciones en todas las esferas de la vida de las pacientes, por lo que el médico de familia debe conocer en profundidad esta patología para optimizar la atención con los mejores recursos disponibles. Los 5 artículos que componen esta revisión ofrecen un resumen de la literatura sobre el cáncer de mama publicada en los últimos 10 años. Este cuarto artículo aborda el tratamiento de la enfermedad, el papel del médico de atención primaria al respecto y el manejo de las principales complicaciones. Esta revisión pretende ofrecer una visión global, actualizada y práctica sobre esta enfermedad que permita resolver los interrogantes que se presentan en la consulta de atención primaria, facilitar respuestas a las mujeres que las soliciten y en definitiva, permanecer al lado de las pacientes a lo largo de su enfermedad con la tranquilidad del conocimiento (AU)

Breast cancer is a prevalent disease affecting all areas of patients’ lives. Therefore, family physicians must thoroughly understand this pathology in order to optimize the health care services and make the best use of available resources, for these patients. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. This fourth article deals with the treatment of the disease, the role of the primary care physician, and management of major complications. This summary report aims to provide a current and practical review about this problem, providing answers to family doctors and helping them to support their patients and care for them throughout their illness (AU)

Effect of low-level laser therapy on pain and swelling in women with breast cancer-related lymphedema: a systematic review and meta-analysis.

PURPOSE: This study aims to examine literature on effectiveness of low-level laser therapy (LLLT) in reducing limb volume and pain in adults with breast cancer-related lymphedema (BCRL). METHODS: PubMed, PEDro, CINAHL, and Cochrane databases were searched using (lymphedema OR edema OR swelling) AND (breast cancer OR mastectomy) AND (laser OR low-level laser therapy OR LLLT OR cold laser). Intervention studies or meta-analyses reporting LLLT for BCRL were included in the search. Pooled effect sizes (ES) and 95 % confidence intervals (CI) were calculated for volume and pain. No limitations were placed on length of follow-up, publication year, or language. Final search was conducted on October 16, 2014. RESULTS: Nine studies met criteria for inclusion. Within-group pooled ES for volume (six studies) was -0.52 (-0.78, -0.25), representing a 75.7-ml reduction in limb volume after LLLT. Between-group pooled ES for volume (four studies) was -0.62 (-0.97, -0.28), representing a 90.9-ml greater reduction in volume with treatment including LLLT versus not including LLLT. Within-group pooled ES for pain reduction (three studies) was -0.62 (-1.06, -0.19), pain reduction of 13.5 mm (0-100 mm VAS). Between-group pooled ES for pain reduction (two studies) was non-significant at -1.21 (-4.51, 2.10). CONCLUSION: Moderate-strength evidence supports LLLT in the management of BCRL, with clinically relevant within-group reductions in volume and pain immediately after conclusion of LLLT treatments. Greater reductions in volume were found with the use of LLLT than in treatments without it. IMPLICATIONS FOR CANCER SURVIVORS: LLLT confers clinically meaningful reductions in arm volume and pain in women with BCRL.

Low-level laser therapy in secondary lymphedema after breast cancer: systematic review.

Complex physical therapy is the main treatment for the secondary lymphedema after breast cancer. The low-level laser therapy (LLLT) has been used in order to stimulate lymphangiogenesis, encourage lymphatic motility, and reduce lymphostatic fibrosis. However, these factors could also favor the development of recurrence and metastasis. The objective of this study is to discuss the use of LLLT in the treatment of lymphedema after breast cancer. This study utilized a systematic review on the use of LLLT in the treatment of lymphedema after breast cancer. Evaluating quality of articles was conducted through the PEDro scale. Of the 41 articles identified, four were considered to be of high methodological quality (score ≥ 5). The low-level laser in the axillary region was performed in all studies. The control group was not similar across studies. The results presented showed that there was a reduction in limb volume in the group subjected to low-power laser when compared with other treatments. No studies have evaluated the risk of metastasis or relapse in the irradiated areas. Because no studies have included the complex physical therapy as the comparison group, we cannot claim that laser treatment is the best efficacy or effectiveness in lymphedema treatment after breast cancer. No studies have evaluated the hypothesis that the LLLT can increase the risk of recurrence or metastasis. Therefore, the questions about the safety of this procedure in cancer patients remain.

A systematic review of the effect of low-level laser therapy in the management of breast cancer-related lymphedema.

PURPOSE: The purpose of this study was to review the effect of low-level laser therapy (LLLT) in the management of breast cancer-related lymphedema (BCRL). METHODS: A systematic review of seven databases for clinical trials for LLLT in the management of BCRL published between 1990 and 2011 was performed. RESULTS: A total of eight studies on 230 patients were found. The methodological qualities of the selected studies were assessed with the Physiotherapy Evidence Database scale, and the studies were categorized according to Sackett's levels of evidence. Five studies were graded at evidence level II. Two studies were graded at evidence level III, and the remaining study was graded at evidence level V. CONCLUSIONS: There is moderate to strong evidence for the effectiveness of LLLT for the management of BCRL from five small studies of acceptable methodological quality. A dose of 1-2 J/cm(2) per point applied to several points covering the fibrotic area can reduce limb volume following BCRL. Further well-designed, large-scale studies are required to determine more precisely how effective LLLT may be in BCRL.

Treatment of post-mastectomy lymphedema with laser therapy: double blind placebo control randomized study.

BACKGROUND: In post-mastectomy patients, lymphedema has the potential to become a permanent progressive condition and become extremely resistant to treatment. Thus, it can results in function impairment and decrease quality of life. The aim of this study was to evaluate the effect of low level laser therapy (LLLT) on limb volume, shoulder mobility, and hand grip strength. MATERIAL AND METHODS: Fifty women with breast cancer-related lymphedema were enrolled in a double-blind, placebo controlled trial. Patients were randomly assigned to active laser (n = 25) and placebo (n = 25) groups and received irradiation with Ga-As laser device that had wavelength of 904 nm, power of 5 mW, and spot size of 0.2 cm(2) over the axillary and arm areas, three times a week for 12 wk. The total energy applied at each point was 300 mjoules over seven points, giving a dosage of 1.5 joules/cm(2) in the active group. The placebo group received placebo therapy in which the laser had been disabled without affecting its apparent function. Limb circumference, shoulder mobility, and grip strength were measured before treatment and at 4, 8, and 12 wk. RESULTS: The two groups had similar parameters at baseline. The reduction of limb volume tended to decline in both groups. The trend being more significantly pronounced in active LLLT group than placebo at 8 and 12 wk, respectively (P < 0.05). Goniometric data for shoulder mobility and hand grip strength were statistically significance for LLLT group than for placebo. CONCLUSION: Laser treatment was found to be effective in reducing the limb volume, increase shoulder mobility, and hand grip strength in approximately 93% of patients with postmastectomy lymphedema.

The short-term effects of low-level laser therapy in the management of breast-cancer-related lymphedema.

BACKGROUND: Breast-cancer-related lymphedema (BCRL) is a chronic disease, and currently there is no definitive treatment for it. There are some therapeutic interventions targeted to decrease the limb swelling and the associated problems. Low-level laser therapy (LLLT) has been used in the treatment of post-mastectomy lymphedema since 2007 in the US. The aim of this study is to review our short-term experience with LLLT in the treatment of BCRL. METHOD: Seventeen BCRL patients referred to our lymphedema program between 2007 and 2009 were enrolled in this study. All patients had experienced at least one conventional treatment modality such as complex physical therapy, manual lymphatic drainage, and/or pneumatic pump therapy. LLLT was added to patients' ongoing therapeutic regimen. All patients completed the full course of LLLT consisting of two cycles. The difference between sums of the circumferences of both affected and unaffected arms (ΔC), pain score, scar mobility, and range of motion were measured before and after first and second cycles of LLLT sequentially. RESULTS: All patients were female with a median age of 51.8 (44-64) years. ΔC decreased 54% (15-85%) and 73% (33-100%), after the first and second cycles of LLLT, respectively. Fourteen out of seventeen experienced decreased pain with motion by an average of 40% (0-85%) and 62.7% (0-100%) after the first and second cycle of LLLT, respectively. Three patients had no improvement in pain after LLLT. Scar mobility increased in 13 (76.4%) and shoulder range of motion improved in 14 (82.3%) patients after LLLT. One patient developed cellulitis during LLLT. CONCLUSION: Patients with BCRL received additional benefits from LLLT when used in conjunction with standard lymphedema treatment. These benefits include reduction in limb circumference, pain, increase in range of motion and scar mobility. Additionally, two cycles of LLLT were found to be superior to one in this study.

Changes in tissue water and indentation resistance of lymphedematous limbs accompanying low level laser therapy (LLLT) of fibrotic skin.

Our goal was to determine effects of low-level-laser-therapy (LLLT) on skin water and tissue indentation resistance (TIR) in patients with arm (N = 38) or leg (N = 38) lymphedema. Skin water was determined from tissue dielectric constant (TDC) measurements and TIR determined from measurements of force resulting from tissue indentations of 3-4 mm. A limb-location with fibrosis was identified by palpation and treated with an LLLT device for one minute at each of five points within a 3 cm2 area. TDC and TIR at these sites and corresponding sites on the contralateral limb were measured prior to LLLT (pre-LLLT), immediately after LLLT (post-LLLT) and after a manual lymphatic drainage (MLD) session (post-MLD). Results, from arms and legs, showed that post-LLLT values of TIR and TDC were significantly less than pre-LLLT. TIR values remained significantly reduced at post-MLD whereas TDC values were not significantly different from pre-LLLT values. On follow-up visit, 17 previously LLLT treated legs were sham treated with an inactive LLLT unit and measurements replicated. A TIR and TDC change-pattern similar to that obtained with the active LLLT was obtained, but sham-related reductions in TIR and TDC immediately post sham-treatment were significantly less than achieved with the prior active LLLT treatment.

Managing postmastectomy lymphedema with low-level laser therapy.

OBJECTIVE: We aimed to investigate the effects of low-level laser therapy (LLLT) in managing postmastectomy lymphedema. BACKGROUND DATA: Postmastectomy lymphedema (PML) is a common complication of breast cancer treatment that causes various symptoms, functional impairment, or even psychosocial morbidity. A prospective, single-blinded, controlled clinical trial was conducted to examine the effectiveness of LLLT on managing PML. METHODS: Twenty-one women suffering from unilateral PML were randomly allocated to receive either 12 sessions of LLLT in 4 wk (the laser group) or no laser irradiation (the control group). Volumetry and tonometry were used to monitor arm volume and tissue resistance; the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire was used for measuring subjective symptoms. Outcome measures were assessed before and after the treatment period and at the 4 wk follow-up. RESULTS: Reduction in arm volume and increase in tissue softening was found in the laser group only. At the follow-up session, significant between-group differences (all p < 0.05) were found in arm volume and tissue resistance at the anterior torso and forearm region. The laser group had a 16% reduction in the arm volume at the end of the treatment period, that dropped to 28% in the follow-up. Moreover, the laser group demonstrated a cumulative increase from 15% to 33% in the tonometry readings over the forearm and anterior torso. The DASH score of the laser group showed progressive improvement over time. CONCLUSION: LLLT was effective in the management of PML, and the effects were maintained to the 4 wk follow-up.

Efficacy of pneumatic compression and low-level laser therapy in the treatment of postmastectomy lymphoedema: a randomized controlled trial.

OBJECTIVE: To compare the long-term efficacy of pneumatic compression and low-level laser therapies in the management of postmastectomy lymphoedema. DESIGN: Randomized controlled trial. SETTING: Department of Physical Medicine and Rehabilitation of Cukurova University, Turkey. SUBJECTS: Forty-seven patients with postmastectomy lymphoedema were enrolled in the study. INTERVENTIONS: Patients were randomly allocated to pneumatic compression (group I, n=24) and low-level laser (group II, n=23) groups. Group I received 2 hours of compression therapy and group II received 20 minutes of laser therapy for four weeks. All patients were advised to perform daily limb exercises. MAIN MEASURES: Demographic features, difference between sum of the circumferences of affected and unaffected limbs (delta C), pain with visual analogue scale and grip strength were recorded. RESULTS: Mean age of the patients was 48.3 (10.4) years. Delta C decreased significantly at one, three and six months within both groups, and the decrease was still significant at month 12 only in group II (P = 0.004). Improvement of group II was greater than that of group I post treatment (P = 0.04) and at month 12 after 12 months (P = 0.02). Pain was significantly reduced in group I only at posttreatment evaluation, whereas in group II it was significant post treatment and at follow-up visits. No significant difference was detected in pain scores between the two groups. Grip strength was improved in both groups, but the differences between groups were not significant. CONCLUSIONS: Patients in both groups improved after the interventions. Group II had better long-term results than group I. Low-level laser might be a useful modality in the treatment of postmastectomy lymphoedema.

Dramatic reduction of chronic lymphoedema of the lower limb with sorafenib therapy.

This paper describes an interesting case report based on a patient who had a dramatic and astounding reduction in her chronic lymphoedema while on sorafenib.

Reduction of lymphedema using complete decongestive therapy: roles of prior radiation therapy and extent of axillary dissection.

Although radiation therapy (RT) contributes to lymphedema (LE), it is unknown whether RT contributes to more difficulty (more treatments) or less success (decreased LE reduction) with therapy for established LE. We reviewed the results of complete decongestive therapy (CDT) for LE with respect to a history of RT and the number of lymph nodes dissected. Breast cancer survivors with LE were referred to CDT-certified therapists. CDT consists of treatment (phase 1) and maintenance (phase 2) phases. During phase 1, the patient meets with a therapist daily until the LE reduction plateaus; then phase 2 (self-care) begins. During phase 1, LE is quantified weekly at a minimum. Fifty-three patients underwent CDT and completed phase 1. The median number of treatments to plateau was 12 (range 6-25); the median limb volume reduction was 36% (-4-119%). Thirty-six patients with an RT history had an insignificant difference in LE reduction (p = .49) and the number of sessions to plateau (p = .54) compared with 17 patients without RT. The median examined number of nodes was 12 (range 3-28). No significant correlation was observed between the number of nodes examined and percent reduction (r = -.390); no significant correlation (r = .291; critical r = .396 for p = .05 for both cases) was observed between the number of nodes sampled and the number of sessions to plateau. Patients with LE obtained relief regardless of whether they received surgery or surgery plus RT. The insignificant correlation between the number of lymph nodes and percent reduction could become significant with a larger sample size.

Low-level laser therapy in management of postmastectomy lymphedema.

The aim of this paper was to study the effects of low-level laser therapy (LLLT) in the treatment of postmastectomy lymphedema. Eleven women with unilateral postmastectomy lymphedema were enrolled in a double-blind controlled trial. Patients were randomly assigned to laser and sham groups and received laser or placebo irradiation (Ga-As laser device with a wavelength of 890 nm and fluence of 1.5 J/cm2) over the arm and axillary areas. Changes in patients' limb circumference, pain score, range of motion, heaviness of the affected limb, and desire to continue the treatment were measured before the treatment and at follow-up sessions (weeks 3, 9, 12, 18, and 22) and were compared to pretreatment values. Results showed that of the 11 enrolled patients, eight completed the treatment sessions. Reduction in limb circumference was detected in both groups, although it was more pronounced in the laser group up to the end of 22nd week. Desire to continue treatment at each session and baseline score in the laser group was greater than in the sham group in all sessions. Pain reduction in the laser group was more than in the sham group except for the weeks 3 and 9. No substantial differences were seen in other two parameters between the two treatment groups. In conclusion, despite our encouraging results, further studies of the effects of LLLT in management of postmastectomy lymphedema should be undertaken to determine the optimal physiological and physical parameters to obtain the most effective clinical response.