730
PHYSI OTHERAPY TREATMENTS FOR BREAST CANCER-RELATED LYMPHEDEMA:
A LI TERATURE REVI EW
1Nar a Fer nanda Br az da Silv a Leal2 Hélio Hum ber t o Angot t i Car r ar a3 Kar ina Fr anco Vieir a4 Cr ist ine Hom si Jor ge Fer r eir a5
Leal NFBS, Carrara HHA, Vieira KF, Ferreira CHJ. Physiot herapy t reat m ent s for breast cancer- relat ed lym phedem a: a lit er at ur e r ev iew . Rev Lat ino- am Enfer m agem 2009 set em br o- out ubr o; 17( 5) : 730- 7.
Breast cancer is t he second m ost frequent cancer am ong wom en. Surgery is part of t he t herapeut ic process t o prevent m et ast ases, but it can also cause som e com plicat ions, including lym phedem a. Physiot herapy cont ribut es t o it s t reat m ent , using different t echniques t hat have been developed over t he years. This syst em at ic lit erat ure r ev iew aim s t o pr esent phy siot her apy m odalit ies applied for ly m phedem a t her apy . The lit er at ur e r ev iew w as conduct ed using t ext books and Lilacs, Pubm ed and Scielo dat abases, from 1951 t o 2009. Physiot herapy resources used for ly m phedem a t r eat m ent include com plex decongest iv e t her apy ( CDT) , pneum at ic com pr ession ( PC) , high v olt age elect r ical st im ulat ion ( HVES) and laser t her apy . The analy zed lit er at ur e show s t hat bet t er r esult s ar e ob t ain ed w it h com b in ed t ech n iq u es. CDT is t h e m ost u sed p r ot ocol, an d it s associat ion w it h PC h as dem onst r at ed efficacy . The new t echniques HVES and laser pr esent sat isfact or y r esult s.
DESCRI PTORS: ly m phedem a; phy sical t her apy ( specialit y ) ; elect r ical st im ulat ion; laser
TRATAMI ENTOS FI SI OTERAPÉUTI COS PARA EL LI NFEDEMA DESPUÉS DE LA CI RUGÍ A DE
CÁNCER DE SENO: UNA REVI SI ÓN DE LI TERATURA
El cáncer de seno es el segundo t ipo de cáncer m ás com ún ent re las m uj eres. La cirugía es part e del proceso t er apéut ico en la pr ev ención de la disem inación de la enfer m edad, sin em bar go, puede ser causa de algunas com plicaciones com o el linfedem a. La fisiot er apia cont r ibuy e par a su t r at am ient o con difer ent es t écnicas que v ienen siendo desar r olladas a lo lar go de los años. El obj et iv o de est a r ev isión sist em át ica de la lit er at ur a es pr esent ar las m odalidades fisiot er apéut icas aplicadas en el t r at am ient o del linfedem a. La r ev isión bibliogr áfica fue efect uada en libros t ext os y en las bases de dat os LI LACS, PubMed y SciELO, en el período de 1951 a 2009. En t r e los r ecu r sos f isiot er ap éu t icos u t ilizad os en el t r at am ien t o d el lin f ed em a est án la t er ap ia com p lej a descongest iv a ( TCD) , com pr esión neum át ica ( CN) , est im ulación eléct r ica de alt o v olt aj e ( EVA) y láser t er apia. Los t r abaj os analizados m uest r an que los r esult ados son m ej or es con las t écnicas com binadas. La TCD es el prot ocolo m ás ut ilizado, y su asociación con la CN se m uest ra eficaz. Las nuevas t écnicas EVA y láser present an r esu lt ados sat isf act or ios.
DESCRI PTORES: linfedem a; t er apia física ( especialidad) ; est im ulación eléct r ica; laser
TRATAMENTOS FI SI OTERAPÊUTI COS PARA O LI NFEDEMA PÓS-CÂNCER DE MAMA:
UMA REVI SÃO DE LI TERATURA
O câncer de m am a é o segundo t ipo de câncer m ais com um ent re as m ulheres. A cirurgia é part e do processo t er apêut ico na pr ev enção da dissem inação da doença, por ém , pode ser causa de algum as com plicações com o o linfedem a. A fisiot erapia cont ribui para seu t rat am ent o com diferent es t écnicas que vêm sendo desenvolvidas ao longo dos anos. O obj et ivo dest a revisão sist em át ica da lit erat ura é apresent ar as m odalidades fisiot erapêut icas aplicadas n o t r at am en t o do lin fedem a. A r ev isão bibliogr áfica foi efet u ada em liv r os t ex t os e n as bases de dados LI LACS, PubMed e SciELO, no per íodo de 1951 a 2009. Ent r e os r ecur sos fisiot er apêut icos ut ilizados no t r at am en t o d o l i n f ed em a est ão a t er ap i a co m p l ex a d esco n g est i v a ( TCD) , co m p r essão p n eu m át i ca ( CP) , est im ulação elét rica de alt a volt agem ( EVA) e lasert erapia. Os t rabalhos analisados m ost ram que os result ados são m elhores com as t écnicas com binadas. A TCD é o prot ocolo m ais ut ilizado, e sua associação com a CP se m ost r a eficaz. As nov as t écnicas EVA e laser apr esent am r esult ados sat isfat ór ios.
DESCRI TORES: lin fedem a; fisiot er apia ( especialidade) ; elet r oest im u lação; laser
1This research was support ed by FAPESP ( Process # 2007/ 50115- 8) ; 2Physical Therapist , e- m ail: nanda.t az@bol.com .br; 3Facult y, Faculdade de Medicina de
Ribeir ão Pr et o, Univ er sidade de São Paulo, Brazil, e- m ail: hhacar ra@fm r p.usp.br ; 4Visit ing Pr ofessor, Univ er sidade de Ribeir ão Pr et o, Brazil, e- m ail:
karinafvieira@yahoo.com .br; 5Facult y, Faculdade de Medicina de Ribeirão Pret o, Universidade de São Paulo, Brazil, e- m ail: crist ine@fm rp.usp.com .br.
Disponible en castellano/ Disponível em língua portuguesa SciELO Brasil w w w .scielo.br/ rlae
Rev Lat ino- am Enferm agem 2009 set em bro- out ubro; 17( 5) : 730- 6 w w w .eer p.usp.br / r lae
I NTRODUCTI ON
B
r east can cer is on e of t h e m ost com m on t y p es am on g w om en an d can lead t o h ig h m or b id it yan d m o r t al i t y r at es. Su r g er i es p er f o r m ed as p ar t
o f b r e a st ca n ce r t r e a t m e n t i n cl u d e ( r a d i ca l a n d
m o d i f i e d ) m a s t e c t o m i e s a n d c o n s e r v a t i v e
su r g er i es. I n d ep en d en t l y o f w h at t y p e o f su r g er y
i s p e r f o r m e d , t h e s e t e c h n i q u e s c a n b e
a c c o m p a n i e d b y a x i l l a r y l y m p h n o d e d r a i n a g e ,
w h i ch m ay cau se u p p er l i m b l y m p h ed em a( 1 - 4 ). As
a p ar t of t r eat m en t , p h y siot h er ap y p lay s a r ole in
p o st o p e r a t i v e p h y si ca l r e h a b i l i t a t i o n , p r e v e n t i n g
a n d t r e a t i n g c o m p l i c a t i o n s l i k e l y m p h e d e m a ,
d e cr e a se m o v e m e n t r a n g e o f u p p e r l i m b j o i n t s,
c o r r e c t i n g p o s t u r a l m i s a l i g n m e n t a n d s e n s i t i v e
a l t e r a t i o n s a n d , t h u s , p r o m o t i n g f u n c t i o n a l
r ecov er y an d a b et t er q u alit y of lif e( 1 ).
Af t er su r g er y an d r em ov al or r ad i at i on of
r egion al ly m ph ch ain s, pat ien t s can pr esen t , am on g
o t h er co m p l i ca t i o n s, u p p er l i m b l y m p h ed em a( 3 , 5 ).
I t s i n c i d e n c e d e p e n d s o n d i f f e r e n t v a r i a b l e s ,
i n cl u d i n g t h e ex t en t o f ax i l l ar y su r g er y, p r esen ce
o f o b esi t y, r ecu r r en ce o f can cer i n ax i l l ar y l y m p h
n o d e s a n d r a d i o t h e r a p y( 6 ). I t m a y o ccu r a l m o st
s u b s e q u e n t l y t o s u r g i c a l t r e a t m e n t , d u r i n g
r a d i o t h e r a p y o r m a n y m o n t h s o r y e a r s a f t e r
t r eat m en t con clu sion( 3 ). Ly m p h ed em a is d ef in ed as
t h e ex cessiv e an d p er sist en t accu m u lat ion of f lu id
a n d e x t r a v a s c u l a r a n d e x t r a c e l l u l a r p r o t e i n s i n
t i s s u e s p a c e s , d u e t o t h e i n e f f i c i e n c y o f t h e
ly m p h at ic sy st em( 3 ). Ly m p h ed em a- associat ed sig n s
a n d sy m p t o m s a r e i n cr ea sed l i m b d i a m et er, sk i n
t e n si o n i n g w i t h r i sk o f b r e a k d o w n a n d i n f e ct i o n ,
st if f n ess an d d ecr eased r an g e of m ov em en t ( ROM)
o f a f f e ct e d l i m b j o i n t s, se n so r y d i so r d e r s i n t h e
h a n d a n d r e d u ce d u se o f t h e l i m b f o r f u n ct i o n a l
t a s k s( 3 ). Co n s e q u e n t l y, i t c a n r e s u l t i n e s t h e t i c
d ef o r m i t i es, d ecr eased f u n ct i o n al ab i l i t y, p h y si cal
d i s c o m f o r t , e p i s o d e s o f e r y s i p e l a s a n d
p sy ch o l o g i ca l st r ess( 6 ).
H e n c e , l y m p h e d e m a i s o n e o f t h e m a i n
p r o b l e m s a f t e r b r e a s t c a n c e r s u r g e r y a n d
r a d i o t h e r a p y. I t i s e x t r e m e l y i m p o r t a n t t o se e k
al t er n at i v es f o r i t s r ed u ct i o n an d co n t r o l . D u e t o
t h e sev er it y of com p licat ion s r esu lt in g f r om p ost
-su r g ical ly m p h ed em a, t h is lit er at u r e r ev iew aim ed
t o pr esen t an d discu ss t h e r esu lt s of r esear ch t h at
e x a m i n e d t h e r e su l t s o f d i f f e r e n t p h y si o t h e r a p y
m o d al i t i es u sed f o r t r eat i n g l y m p h ed em a.
METHOD
A sy st em at ic lit er at u r e r ev iew w as car r ied
o u t . T h e f o l l o w i n g e l e c t r o n i c d a t a b a s e s w e r e
i n v e s t i g a t e d : L a t i n A m e r i c a n a n d Ca r i b b e a n
Lit er at u r e ( LI LACS) , Pu b Med an d SciELO, cov er in g
t h e p er iod f r om 1 9 8 1 t o 2 0 0 9 , 1 9 5 1 t o 2 0 0 9 an d
2 0 0 1 t o 2 0 0 4 , r e s p e c t i v e l y . A l s o , d a t a f r o m
p h y si o t h e r a p y t e x t b o o k s w e r e su r v e y e d , ci t e d i n
r ef er en ces 1 , 2 , 3 an d 4 .
I n LI LACS, t h e f o l l o w i n g co m b i n a t i o n s o f
d e s c r i p t o r s w e r e u s e d : l i n f e d e m a , l i n f e d e m a x m e m b r o s u p e r i o r , l i n f e d e m a x m a s t e c t o m i a , lin f ed em a x f isiot er ap ia, lin f ed em a x m ast ect om ia x f i s i o t e r a p i a , t r a t a m e n t o x l i n f e d e m a x m ast ect o m i a, d r en ag em l i n f át i ca x l i n f ed em a. No c i t a t i o n s w e r e f o u n d f o r t e r a p i a c o m p l e x a d esco n g est i v a an d t er a p i a f ísi ca d esco n g est i v a.
Nex t , t h e k ey w or d s u sed in Pu b Med w er e
v e r i f i e d : p o s t m a s t e c t o m y l y m p h e d e m a , p h y si o t h e r a p y u p p e r l i m b l y m p h e d e m a, co m p l e x d e c o n g e s t i v e p h y s i o t h e r a p y. M a n u s c r i p t s w e r e f o u n d f o r al l o f t h ese d escr i p t o r s. I n Sci ELO, t h e
f ollow in g k ey w or ds w er e in v est igat ed: m ast ect om y x l y m p h e d e m a , m a s t e c t o m y x l y m p h e d e m a x p h y s i o t h e r a p y , l y m p h e d e m a x p h y s i o t h e r a p y , m a n u a l l y m p h a t i c d r a i n a g e. Ci t at i o n s w er e f o u n d f or t h e f ir st com b in at ion on ly.
M a n u s c r i p t s i d e n t i f i e d i n a l l e l e c t r o n i c
d a t a b a se s w e r e i n cl u d e d i n t h i s r e v i e w p r o v i d e d
t h at t h e f u ll v er sion of or igin al ar t icles w as av ailable
t h r ou gh open access, in Por t u gu ese or En glish , an d
p r ov id ed t h at t h ey m ain ly ad d r essed p h y siot h er ap y
appr oach es t o ly m ph edem a. Eigh t een ar t icles w er e
u sed . Th e f i n al sear ch i n al l el ect r o n i c d at ab ases
w as car r ied ou t on Mar ch 1 3t h 2 0 0 9 .
RESULTS
Th e a r t i cl e s se l e ct e d f o r t h i s r e v i e w a r e
732
Table 1 – Ar t icles select ed in Por t uguese
l a n r u o j r a e y / r o h t u
A Title Methodologicaldesign Aim Results
5 0 0 2 , .l a t e a i c r a G e d a r i e li s a r B a t s i v e R a i p a r e t o i s i F a tl a e d o ã ç a l u m it s e a d s o t i e f E -s ó p a m e d e f n il o n m e g a tl o v a i m o t c e t s a m d e t a e p e r h t i w l a i r t l a c i n il C s e r u s a e m 5 1 = N S E V H f o s t c e f f e e h t e z y l a n A n i a m e d e h p m y l b m il r e p p u n o n e m o w d e z i m o t c e t s a m a m e d e h p m y l f o n o it c u d e R d n a e m u l o v , s r e t e m i r e p y t i r e v e s 5 0 0 2 , .l a t e a i c r a G e d a r i e li s a r B a t s i v e R a i g o l o t s a M s o s r u c e r s e t n e r e f i d e d o ã ç a il a v A o d e l o r t n o c o n s o c it u ê p a r e t o i s if a i m o t c e t s a m -s ó p a m e d e f n il y d u t s d e z i m o d n a R 0 2 = N S E V H f o s t c e f f e e h t e z y l a n A e g a n i a r d c it a h p m y l d n a h t i w d e t a i c o s s a e g a s s a m a m e d e h p m y l n o n o i s s e r p m o c n o it c u d e r e m u l o v r e t a e r G S E V H h t i w 6 0 0 2 , .l a t e s e ll e r i e M e d a r i e li s a r B a t s i v e R a i p a r e t o i s i F s a c i n c é t e d o ã ç a il a v A o t n e m a t a r t o n s a c it u ê p a r e t o i s if e d a i g r u r i c -s ó p a m e d e f n il o d s e r e h l u m m e a m a m y d u t s t r o h o C 6 3 = N f o y c a c if f e s s e s s A a r o f t n e m t a e r t a m e d e h p m y l s r a e y o w t o t p u f o d o i r e p d n a n o it c u d e r a m e d e h p m y L d e i d u t s g n i r u d e c n a n e t n i a m s d o i r e p 7 0 0 2 , .l a t e a i c r a G a s i u q s e P e a i p a r e t o i s i F a c i r t é l e o ã ç a l u m it s e a d s o t i e f E a m e d e f n il o n m e g a tl o v a tl a e d :l a r e t a li b a i m o t c e t s a m -s ó p o s a c e d o d u t s e t r o p e r e s a C 3 = N S E V H f o t c e f f e e h t s s e s s A a m e d e h p m y l l a r e t a li b n o -t s o p t n a t r o p m i y ll a c i n il C e h t f o n o it c u d e r t n e m t a e r t a m e d e h p m y l 8 0 0 2 , .l a t e a r i e v il O e d a r i e li s a r B a t s i v e R a i p a r e t o i s i F a i p a r e t o i s if a d a i c n ê u lf n I a v it s e g n o c s e d a x e l p m o c e d o ã t s e g n i à a d a i c o s s a a i d é m a i e d a c e d s o e d í r e c il g i r t e d a m e d e f n il o d o t n e m a t a r t o n r o i r e p u s o r b m e m y d u t s d e z i m o d n a r , d n il B 0 1 = N T D C f o e c n e u lf n i e h t s s e s s A y p a r e h t t e i d h t i w d e t a i c o s s a n i n o it n e v r e t n i f o m r o f a s a a m e d e h p m y l b m il r e p p u n i n o it c u d e r t n a c if i n g i s e r o M n i e m u l o v d n a e c n e r e f m u c r i c -m u i d e m g n i s u p u o r g e h t s e d i r e c y l g i r t n i a h c
Table 2 - Art icles select ed in English
l a n r u o j r a e y / r o h t u
A Title Methodologicaldesign Aim Results
8 9 9 1 , .l a t e i n i D y g o l o c n O f o s l a n n A n i n o i s s e r p m o c c it a m u e n p f o e l o r e h T y m o t c e t s a m t s o p f o t n e m t a e r t II I e s a h p d e z i m o d n a r A . a m e d e h p m y l y d u t s y d u t s d e z i m o d n a R 0 8 = N c it a m u e n p f o e s u e h t e r a p m o C p u o r g l o r t n o c a h t i w n o i s s e r p m o c a m e d e h p m y l y m o t c e t s a m t s o p n i t n e m t a e r t e r e w b m il e h t n i s e c n e r e f f i d o N r e d n u s p u o r g e h t n e e w t e b d n u o f s i s y l a n a 8 9 9 1 , .l a t e c u d e L r e c n a C n a c i r e m A y t e i c o S b m il r e p p u f o t n e m t a e r t l a c i s y h p e h T a m e d e d e t a e p e r h t i w l a i r t l a c i n il C s e r u s a e m 0 2 2 = N l a u n a m f o e s u e h t s s e s s A , ) D L M ( e g a n i a r d c it a h p m y l n i C P d n a s e g a d n a b d e r e y a li tl u m t n e m t a e r t a m e d e h p m y l n i n o it c u d e r b m il t n a t r o p m i t s o M t n e m t a e r t f o k e e w t s r if e h t 8 9 9 1 , .l a t e o K g r u S h c r A f o a m e d e h p m y l f o t n e m t a e r t e v it c e f f E s e it i m e r t x e e h t y d u t s e v it c e p s o r P 9 9 2 = N -g n o l d n a e t a i d e m m i e h t s s e s s A h t i w s b m il f o e m u l o v m r e t T D C r e t f a a m e d e h p m y l n i a m e d e h p m y l f o n o it c u d e R s e r u s a e m h t i w , 1 e s a h p t n e m t a e r t r e d n u s d o i r e p n i d e n i a t n i a m s i s y l a n a 0 0 0 2 , .l a t e n e s r e d n A a c i g o l o c n O a t c A -d e t a l e r -r e c n a c -t s a e r b f o t n e m t a e r T l a u n a m t u o h t i w r o h t i w a m e d e h p m y l d e z i m o d n a r A . e g a n i a r d c it a h p m y l y d u t s y d u t s d e z i m o d n a R 2 4 = N a o t D L M g n i d d a f i s s e s s A s e v o r p m i y p a r e h t d r a d n a t s a m e d e h p m y l t o n d i d t n e m t a e r t o t D L M g n i d d A s tl u s e r r e t t e b o t e t u b i r t n o c 2 0 0 2 , .l a t e a b u z S r e c n a C n a c i r e m A y t e i c o S r o f y p a r e h t c it a h p m y l e v it s e g n o c e D -a m o n i c r a c t s a e r b h t i w s t n e it a p a m e d e h p m y l d e t a i c o s s a e v it c e p s o r p d e z i m o d n a R y d u t s 3 2 = N f o y t e f a s d n a y c a c if f e e h t s s e s s A n i T D C h t i w d e t a i c o s s a C P a m e d e h p m y l h t i w n e m o w n e h w r e t t e b e r e w s tl u s e r d e n i a t b O P C d n a T D C g n it a i c o s s a 3 0 0 2 , .l a t e it a r a C r e c n a C n a c i r e m A y t e i c o S y m o t c e t s a m t s o p f o t n e m t a e r T r e s a l l e v e l -w o l h t i w a m e d e h p m y l y p a r e h t , d n il b -e l b u o D -o b e c a l p , d e z i m o d n a r y d u t s d e ll o r t n o c 1 7 = N n i r e s a l f o e s u e h t s s e s s A y m o t c e t s a m t s o p h t i w s t n e it a p a m e d e h p m y l e n o r e t f a n o it c u d e r e m u l o v b m i L f o s e l c y c 2 g n i s u s h t n o m e e r h t r o y p a r e h t r e s a l 3 0 0 2 , .l a t e e i z n e k c M l a c i n il C f o l a n r u o J y g o l o c n O n o e s i c r e x e y t i m e r t x e r e p p u f o t c e f f E t s a e r b n i a m e d e h p m y l y r a d n o c e s y d u t s t o li p a : s t n e it a p r e c n a c y d u t s t o li P 4 1 = N e s i c r e x e n a f o t c e f f e e h t s s e s s A r e t f a a m e d e h p m y l n o m a r g o r p r e c n a c t s a e r b d e v o r p m i s e s i c r e x e f o n o it a c il p p A e f il f o y t il a u q 6 0 0 2 , .l a t e e d n e z e R i r o m u T n i s e m e h c s e s i c r e x e o w T : r e c n a c t s a e r b e v it a r e p o t s o p r e d l u o h s n o s t c e f f e f o n o s i r a p m o c e c n a b r u t s i d c it a h p m y l d n a t n e m e v o m i r o m u t d e z i m o d n a r e v it c e p s o r P y d u t s l a c i n il c d e ll o r t n o c 0 6 = N e s i c r e x e o w t f o s t c e f f e e r a p m o C n o it c n u f s y d r e d l u o h s n o s e m e h c s c it a h p m y l y m o t c e t s a m -t s o p d n a r e d r o s i d f o t n e m e v o m f o e g n a r r e t t e B d e t c e r i d e h t h t i w r e d l u o h s d e t c e f f a p u o r g e s i c r e x e 7 0 0 2 , .l a t e l u o K n o it a i d a R . J . t n I s y h P .l o i B y g o l o c n O e v it s e g n o c e d e t e l p m o c f o y c a c if f E c it a h p m y l l a u n a m d n a y p a r e h t d e t a l e r -t n e m t a e r t n o e g a n i a r d r e c n a c t s a e r b n i a m e d e h p m y l y d u t s l o r t n o c -e s a C 8 3 1 = N a f o s tl u s e r e h t s s e s s A m a r g o r p t n e m t a e r t a m e d e h p m y l d o i r e p r a e y -o w t a g n i r u d ll a n i e m u l o v b m il f o n o it c u d e R d e s s e s s a s p u o r g 7 0 0 2 , .l a t e r e m m a H l a c i g r u S f o s l a n n A y g o l o c n O e h t s e c u d e r y p a r e h t a m e d e h p m y L s t n e it a p n i n i a p d n a a m e d e f o e m u l o v r e c n a c t s a e r b h t i w d e t a e p e r h t i w l a i r t l a c i n il C s e r u s a e m 5 3 1 = N r o f T D C f o s tl u s e r e h t s s e s s A r e c n a c t s a e r b r e t f a a m e d e h p m y l T D C f o tl u s e r a s a n o it c u d e r n i a P n o it a c il p p a 7 0 0 2 , .l a t e s e n g i V s e R r e c n a C t s a e r B t a e r T t s a e r b f o t n e m e g a n a m m r e t -g n o L r e t f a a m e d e h p m y l d e t a l e r -r e c n a c y p a r e h t o i s y h p e v it s e g n o c e d e v i s n e t n i y d u t s t r o h o c e v it c e p s o r P 7 3 5 = N e c n a n e t n i a m f o t c e f f e e h t s s e s s A e m u l o v a m e d e h p m y l n o y p a r e h t n o it c u d e r g n i r u d n o it c u d e r e m u l o v b m i L e s a e r c n i d n a e s a h p e v i s n e t n i e s a h p e c n a n e t n i a m g n i r u d 8 0 0 2 , .l a t e k a b i d a r a K e v i s n e t n i f o l a i r t e v it c e p s o r P r e p p u r o f y p a r e h t o i s y h p e v it s e g n o c e d a m e d e h p m y l y t i m e r t x e y d u t s e v it c e p s o r P 2 6 = N n o T D C f o t c e f f e e h t s s e s s A f o r a e f d n a e f il f o y t il a u q a m e d e h p m y l n i t n e m e v o m s t n e it a p d n a e m u l o v d e s a e r c e D , b m il d e t c e f f a e h t f o e c n e r e f m u c r i c d n a t n e m e v o m f o r a e f d e s a e r c e d tl u s e r a s a e f il f o y t il a u q d e v o r p m i T D C f o 9 0 0 2 , .l a t e i a s T r e c n a C e r a C t r o p p u S e h t e c a l p e r e p a t o i s e n i K d l u o C c it a h p m y l e v it s e g n o c e d n i e g a d n a b d e t a l e r -r e c n a c -t s a e r b r o f y p a r e h t y d u t s t o li p A ? a m e d e h p m y l y d u t s t o li P 1 4 = N d n a C P + T D C e r a p m o C n i C P + T D C d e if i d o m t n e m t a e r t a m e d e h p m y l e c a l p e r n a c e p a t o i s e n i K g n i r u d e g a d n a b l a n o it i d a r t t n e m t a e r t a m e d e h p m y l
Rev Lat ino- am Enferm agem 2009 set em bro- out ubro; 17( 5) : 730- 6 w w w .eer p.usp.br / r lae
Physiotherapy treatm ents for breast cancer-related…
Th e an al y zed ar t i cl es r ev eal ed t h at , o n ce
inst alled, t he lym phedem a could be cont rolled but not cured( 7). I t can be significant ly reduced during t he first
week of t reat m ent and less significant ly aft er t he t hird w eek( 8 ). As fr om t his m om ent , t r eat m ent should be
cont inued t o m aint ain t he ear lier achiev ed r educt ion, collaborat ing t o reduce t he incidence of infect ions and
im prove qualit y of life( 9). The m ost sat isfact ory result s ar e obt ain ed w h en t r eat m en t is st ar t ed as soon as
t he first signs of lym phedem a appear. No fibrosis exist s in t his phase yet and elast ic t issue is funct ional( 7,10- 11).
I n depen den t ly of t h e t r eat m en t ph ase, sk in car e is
recom m ended, which includes keeping t he skin clean, h y d r a t e d a n d e l a st i c; ca r e w i t h n a i l cu t t i n g a n d
depilat ing; avoiding any t ype of inj ury and infect ions; using rubber gloves for kit chen, sewing and gardening
w o r k ; a v o i d i n g c o n t a c t w i t h a b r a s i v e c h e m i c a l product s and hot bat hs( 3- 4) . This care is valid for t he
p at ien t ’s lif et im e. Lit er at u r e in d icat es t h e f ollow in g p h y siot h er ap y r esou r ces as a f or m of ly m p h ed em a
t r ea t m en t : co m p l ex d eco n g est i v e t h er a p y ( CD T) , pneum at ic com pr ession ( CP) , high v olt age elect r ical
st im ulat ion ( HVES) and laser t herap y.
Com p lex d econ g est iv e t h er ap y
Co m p l ex d eco n g est i v e t h er ap y ( CDT) i s a
m et h od t h at com b in es m an u al ly m p h at ic d r ain ag e ( MLD ) , co m p r essi o n b a n d a g es, m y o l y m p h o k i n et i c
ex er ci ses, sk i n car e an d p r ecau t i o n s d u r i n g d ai l y act ivit ies. One im port ant t echnique used in MLD, which
com prises a set of slow, rhyt hm ic and light m aneuvers
t hat follow t he sense of phy siological dr ainage, and aim s t o clear t h e ly m p h v essels an d im p r ov e f lu id
absorpt ion and t ransport at ion( 2,8,12). The effect s of t his t echnique include dilat ing t issue channels, favoring t he
form at ion of new lym phat ic anast om oses, st im ulat ing t he lym ph vessels and m obilit y of lym phangions w it h
incr ease of t he filt er ed flow and r enew al of defense cells( 1- 2,4). Com pression bandages act by m odifying t he
capillary dynam ics of veins, lym ph vessels and t issues. I t can b e ap p l i ed t h r o u g h f u n ct i o n al co m p r essi v e
ban dagin g ( FCB) or elast ic con t ain m en t ( sleev e) . I t
prom ot es increased int erst it ial pressure and increased efficacy of m uscle and j oint pum ping( 2).
The t herapeut ic exercises included in CDT can help t o m ove and drain lym phat ic fluid t o reduce t he
edem a and im prove t he funct ional use of t he involved m e m b e r. Th e i r e f f e ct s, w h i ch f a v o r l y m p h e d e m a
reduct ion, are based on t he com pression of collect ing v essels dur ing m uscle cont r act ion, on t he r educt ion
of soft t issue hy pom obilit y and ly m phat ic st agnat ion
and on st r engt hening and t he pr ev ent ion of m uscle at r oph y( 3 ).
The analyzed st udies appoint CDT as t he m ain l y m p h e d e m a t r e a t m e n t . S t u d i e s u s e d a l l o f i t s
com ponent s( 8- 9,13- 14) or part of t hem( 6,15- 17). Applied t o 36 wom en wit h post - surgical upper lim b lym phedem a,
t he CDT led t o a m ean reduct ion of 30.5% in t he lim b v o l u m e a f t e r t h e i n t e n s i v e p h a s e , w h i c h w a s
m aint ained dur ing t he st udied per iods( 8). I n anot her st udy, concluded w it h 3 5 6 w om en, t he lim b v olum e
was r educed aft er t he int ensive phase w it h CDT, but
m easu r es in cr eased du r in g t h e m ain t en an ce ph ase. The aut hors appoint ed t he lack of adherence t o sleeve
use as t he probable cause of t his increase, as t his is t h e s t a n d a r d t r e a t m e n t t o m a i n t a i n t h e r e s u l t s
obt ained in t he int ensiv e phase( 9).
The applicat ion of CDT report edly cont ribut ed
t o r educe chr onic pain in w om en w it h ly m phedem a, assessed by t he num er ical scale and t he num ber of
adm inist ered analgesics. This w as t he case in 56 out of 76 wom en who report ed pain in t his research( 11). A
st u d y ca r r i ed o u t w i t h 4 4 w o m en co m p a r ed CD T
associat ed w it h PC an d m odif ied CDT ( r eplacem en t of com pr ession bandage by Kinesio t ape) associat ed
w it h PC. I t s r esu lt s su g g est t h at Kin esio t ap e can r e p l a ce t r a d i t i o n a l b a n d a g e s d u r i n g l y m p h e d e m a
t r eat m ent( 13).
CD T a p p l i e d t o 6 2 l y m p h e d e m a p a t i e n t s
effect iv ely r educed t he v olum e and cir cum fer ence of t h e af f ect ed lim b, decr eased t h e f ear of m ov em en t
a n d i m p r o v e d q u a l i t y o f l i f e( 1 4 ). A n o t h e r s t u d y
associat ed physiot her apy t r eat m ent w it h diet t her apy a s a f o r m o f l y m p h e d e m a i n t e r v e n t i o n . Th e
a ss e s sm e n t i n v o l v e d ci r c u m f e r e n c e a n d v o l u m e m easu r em en t , b ioim p ed an ce, cu t an eou s f old s an d
visual analogue scale for feeling of discom fort . I t was concluded t hat physiot herapy, t oget her wit h t he int ake
of m edium - chain t riglycerides ( MCT) , effect ively act ed on t he involut ion of t he disease, part icularly in t erm s
of circum ference, volum e and feeling of heaviness( 15). S t u d i e s h a v e a l s o l o o k e d a t e x e r c i s e
m odalit ies for ly m ph edem a t r eat m en t . Com par in g a
group of w om en w ho exercised ( resist ance + aerobic + st ret ching) wit h a cont rol group ( wit hout any specific
e x e r ci se i n st r u ct i o n ) , i t w a s co n cl u d e d t h a t t h e ex er cise t echnique did not cause any change in t he
per im et er s and v olum e of t he affect ed lim b. Qualit y of lif e in t h is gr ou p im pr ov ed accor din g t o t h e
734
The conclusion w as t hat shoulder ROM becam e m or e
funct ional in t he direct ed exercise group, but t hat no differ ence appear ed bet w een t he gr oups in t er m s of
t he ly m phat ic disor der( 17).
Lit er at u r e also pr esen t s r esu lt s opposed t o
t he abov e( 6, 18). Ex am ining w het her adding MLD t o a t herapy ( exercise, skin care and sleeve use) im proves
t he lym phedem a, t he conclusion was t hat no evidence of bet t er effect s could be found when adding MLD t o
t he t reat m ent( 6). I n anot her st udy of 138 wom en wit h p o s t - b r e a s t c a n c e r s u r g e r y l y m p h e d e m a , t h e
pr ot ocols applied in each gr oup w er e: CDT, MLD and
a program t o be followed at hom e ( self- m assage and ex er cises) . All t h r ee t ech n iqu es ef f ect iv ely r edu ced
t h e v o l u m e o f t h e a f f e c t e d l i m b s , w i t h o u t a n d significant differ ence( 18).
Pn eu m at ic com p r ession
PC or pr essu r e t h er apy is a t ech n iqu e t h at
consist s of com pressed air pum ps, aim ed at pressuring t h e lim b w it h edem a( 2 ). I t is com posed of dif f er en t
for m s of air cham ber s ( glov es or boot s)( 1). Basically,
t wo t ypes of com pression pum p exist : segm ent al, also called sequent ial or dynam ic, and anot her called st at ic
or non segm ent al. St at ic PC involves t he affect ed lim b wit h a single cont inuous high- pressure cham ber, which
com p r esses t h e en t i r e l i m b at on ce. Th i s f or m o f com pression is out of use, as it prom ot es t he collapse
of lym ph vessels and im pair s t he venous syst em( 1- 2). D y n a m i c p r e ssu r e t h e r a p y co n t a i n s a n u m b e r o f
indiv idually r egulable com par t m ent s or not . Usually,
t h er e ar e at least t h r ee com p ar t m en t s t h at f ill u p separat ely, producing a pressure level t hat goes from
d i s t a l t o p r o x i m a l , t u r n i n g f l u i d d r a i n a g e m o r e efficient( 1- 2).
PC has been used in ly m phedem a r educt ion t r eat m ent and it w as concluded t hat no differ ence in
r e d u ct i o n o ccu r r e d i n co m p a r i so n w i t h a co n t r o l group( 19). Som e st udies associat ed com ponent s of CDT
wit h pneum at ic com pression( 20- 21). A random ized st udy, in v olv in g 2 3 ly m ph edem a pat ien t s w it h ou t pr ev iou s
t reat m ent , com pared t wo int ervent ions: CDT + CP and
CDT alone. I n t his group, it was concluded t hat great er lim b v olu m e r edu ct ion w as ach iev ed w h en apply in g
PC and t his result cont inued on furt her evaluat ions. I n t he sam e st udy, PC was com bined w it h self- m assage
a n d sl e e v e u se i n 2 7 p r e v i o u sl y t r e a t e d ch r o n i c ly m phedem a pat ient s and v olum e r educt ion occur r ed
in t his gr oup, as opposed t o t he gr oup t hat w as not subm it t ed t o PC( 20). Anot her r esear ch, inv olv ing 220
wom en during t wo weeks, associat ed MLD, bandaging
and PC for ly m phedem a t r eat m ent and, as a r esult , pr esent ed decr eased lim b per im et er s, m ainly dur ing
t he first week of t reat m ent( 21).
High v olt age elect r ical st im ulat ion
Elect rical st im ulat ion has been used in clinical pract ice t o reduce t he edem a as, by producing m uscle
cont r act ions and r elax at ion, it incr eases t he v enous a n d l y m p h a t i c f l o w( 1 0 ). Am o n g d i f f er en t el ect r i ca l
cu r r en t f or m s, h i g h - v ol t ag e st i m u l at i on ( HVES) i s
cl i n i cal l y i n d i cat ed f o r acu t e an d ch r o n i c p ai n , t o i n c r e a s e t h e s p e e d o f t i s s u e r e g e n e r a t i o n ,
n eu r om u scu lar r eedu cat ion , t o in cr ease t h e v en ou s blood flow and absor b t he edem a( 22). Assum ing t hat
m u scl e p u m p i n g h e l p s i n t h e e d e m a a b so r p t i o n pr ocess, HVES is being used t o act iv at e t he m uscles
around an affect ed body part . A t heoret ical hypot hesis ex ist s t h at t h e elect r ical cur r ent cr eat es a pot en t ial
elect r ical field t hat can induce t he ly m phat ic sy st em t o absor b ex cessiv e fluids( 22).
A st udy used HVES t o t reat 15 volunt eers wit h
u n ilat er al ly m p h ed em a af t er b r east can cer su r g er y and concluded t hat t his t echnique effect ively reduced
t h e p e r i m e t e r s , v o l u m e a n d s e v e r i t y o f t h e ly m p h ed em a( 1 0 ). A case st u dy of 3 v olu n t eer s w it h
b ilat er al ly m p h ed em a ap p lied t h e sam e t r eat m en t ( H VES) a n d a l so a ch i e v e d a cl i n i ca l l y i m p o r t a n t
r ed u ct ion of t h e ly m p h ed em a p ost - t r eat m en t( 7 ). A g r ou p r eceiv in g HVES w as com p ar ed w it h an ot h er
u sin g MLD + sleev e f or ly m p h ed em a con t r ol in 2 0
v o l u n t e e r s . Th a t r e s e a r c h s h o w e d t h a t b o t h t e ch n i q u e s r e d u ce d l y m p h e d e m a p e r i m e t e r s a n d
sev er it y, w it h ou t any sign if ican t dif f er en ce. Volu m e r edu ct ion , on t h e ot h er h an d, w as gr eat er w it h t h e
use of HVES( 23).
Laser t h er apy
Laser refers t o t he product ion of a ray of light r a d i a t i o n , c h a r a c t e r i z e d b y m o n o c h r o m a t i c i t y,
coherence and collim at ion. I t is produced by em it t ing
a large quant it y of ident ical phot ons, using appropriat e energized m at erial. Aft er it s product ion, t he radiat ion
ca n b e r ef l ect ed o n t h e su r f a ce o r p en et r a t e t h e t issues, depending on t he wavelengt h, nat ure of t issue
sur face and incidence angle( 1).
This resource is used in physiot herapy based
on it s ant i- inflam m at or y, analgesic and r egenerat iv e effect s. I t can prom ot e t he inhibit ion of prost aglandin,
Rev Lat ino- am Enferm agem 2009 set em bro- out ubro; 17( 5) : 730- 6 w w w .eer p.usp.br / r lae
Physiotherapy treatm ents for breast cancer-related…
t he form at ion of new blood vessels, and also norm alize
cell m em br ane act iv it y, r egenerat e ner v e fiber s and ly m ph v essels and acceler at e t he healing pr ocess by
st im ulat ing fibr oblast s. The m ost used laser t y pes in cl i n i ca l p r a ct i ce a r e Hel i u m - Neo n i u m ( HeNe) a n d
Gallium Arsenat e ( AsGa)( 1). I t is believed t hat , t o t reat l y m p h e d e m a , t h e l a s e r c a n s t i m u l a t e
l y m p h a n g i o g e n e s i s , l y m p h a c t i v i t y, l y m p h a t i c m ovem ent , m acrophages and t he im m une syst em and
also r educe fibr osis( 24).
Only one r esear ch on laser t her apy t o t r eat
post - m ast ect om y ly m phedem a w as ident ified in t his
lit er at u r e r ev iew( 2 4 ). A r an d om ized st u d y com p ar ed placebo laser, one- cycle and t w o- cycle laser t herapy.
I nvolving 55 pat ient s, t he result s indicat ed a significant reduct ion in t he volum e, ext racellular fluid and solidit y
of t he affect ed m em ber, bet ween 2 and 3 m ont hs aft er t r eat m ent , using 2 cycles of laser t herapy. One- cycle
t reat m ent was m ore significant t han t he placebo, but less t h an t w o- cy cle t r eat m en t( 2 4 ). Resear ch on t h is
t herapeut ic m ode for lym phedem a t reat m ent is in an init ial st age.
DI SCUSSI ON AND FI NAL CONSI DERATI ONS
Ly m phedem a t r eat m ent using CDT, w hich is
w idely used, consist s of t w o phases: int ensive phase and m aint enance phase. I n t he first phase, which aim s
t o a ch i ev e m a x i m u m l i m b v o l u m e r ed u ct i o n w i t h est het ic and funct ional im pr ovem ent , MLD, funct ional
com p r ession b an d ag in g an d ex er cises ar e ap p lied .
I n t h e secon d , self - m assag e, ex er cises an d sleev e use ( elast ic cont ainm ent ) ar e applied. I t s goal is t o
m ai n t ai n t h e r ed u ct i on s ach i ev ed i n t h e i n t en si v e phase for t he longest t im e possible( 2,4). Daily skin care
is necessar y in bot h phases.
The st udies present ed in t he result s appoint ed
t h at isolat ed t ech n iqu es w er e in su f f icien t t o r edu ce t h e l y m p h e d e m a( 1 6 - 1 7 , 2 0 ). Ex e r ci se m o d e s a n d PC
w it h ou t an y associat ion s m ay n ot be ben ef icial, as t h e ly m p h at ic sy st em n eed s t o b e u n b lock ed f ir st ,
which will t hen be m aint ained by t he act ion of m uscle
cont r act ion and t he use of com pr essiv e bandaging( 1) and posit iv e pneum at ic pr essur e( 4). MLD alone is not
effect iv e for ly m ph edem a t r eat m en t eit h er, an d t h e b e st r e su l t s a r e a ch i e v e d w h e n a sso ci a t e d w i t h
com pression and exercises( 1). Com pressive bandaging n o t o n l y m a i n t a i n s b u t a l so i n cr e a se s l y m p h a t i c
a b s o r p t i o n a n d , t o g e t h e r w i t h k i n e s i o t h e r a p y, st im ulat es ly m phat ic funct ioning( 2).
PC can lead t o com p li cat i on s i f t h e u p p er
lym ph conduit s have not been em pt ied and st im ulat ed first( 2).Lym phat ic capillaries are sm all and fragile, wit h
possible inj uries and breakdown due t o high pneum at ic pr essu r e. I n case of in su fficien t deep dr ain age, t h e
body r egion abov e t he pneum at ic cham ber becom es congest ed, which can cause a new lym phedem a area
and r educe ly m ph collect ion capacit y ev en fur t her( 2). This m ay explain t he t echnique’s lack of success when
u sed separ at ely.
As m en t i o n ed , w h en ap p l i ed al o n e, t h ese
t e ch n i q u e s m a y n o t b e e f f i ci e n t f o r l y m p h e d e m a
reduct ion, but replacing one m ode by anot her equally effect ive t reat m ent can produce good result s and t urn
car e less r epet it iv e. MLD w as com par ed w it h HVES an d b ot h t ech n iq u es d em on st r at ed t h eir ab ilit y t o
reduce t he lym phedem a, but t he reduct ion was larger w hen HVES w as used( 23). The st udies in t his r ev iew
t hat used HVES( 7,10,23) applied negat ive- polarit y current w i t h m o t o r - l e v e l i n t e n si t y. Th e r e d u ce d ca p i l l a r y
per m eabilit y t o plasm a pr ot ein, t he effect of m uscle pum ping and repulsion of loads ( negat ive current and
n e g a t i v e p r o t e i n s) ca n e x p l a i n i t s r e su l t s( 7 , 1 0 , 2 2 ).
H o w e v e r, r a n d o m i z e d s t u d i e s w i t h m o r e r epr esent at iv e sam ples ar e needed, w hich can t r uly
dem onst r at e t he efficacy and possible adv ant ages of HVES ov er MLD.
Re s e a r c h t h a t u s e d l a s e r t h e r a p y f o r l y m p h e d e m a r e d u c t i o n i n d i c a t e d t h e f o l l o w i n g
hypot heses for it s effect s: rest ored axillary lym phat ic dr ainage by t he st im ulat ion of new ly m ph conduit s,
soft ening of fibrous t issue and surgical scar, syst em ic
effect s r elat ed t o t he ex t r acellular fluid v olum e and r educt ion of accum ulat ed t issue fluids by blood flow
c h a n g e s . La s e r t h e r a p y a l s o e x e r t s a n a l g e s i c effect s( 24- 25). Put t ing it in pract ice st ill dem ands furt her
r esear ch t h ou gh .
A l t h o u g h p r o f e s s i o n a l l y a d m i n i s t e r e d
t r e a t m e n t d i s p l a y s h i g h l e v e l s o f l i m b v o l u m e reduct ion, t reat m ent perform ed by pat ient s alone can
be useful if t hey cannot get pr ofessional t her apy( 25). Treat m ent as a whole, including elevat ion, t herapeut ic
m assage, ex er cises, com pr ession and dr ugs, is m or e
a d eq u a t e w h en p er f o r m ed b y a n i n t er d i sci p l i n a r y t eam , an d ly m p h at ic r ech an n elin g su r g er y is u sed
when conservat ive t reat m ent is ineffect ive( 26). As part o f i n t e r d i sci p l i n a r y t r e a t m e n t , d i e t t h e r a p y w i t h
m e d i u m - ch a i n t r i g l y ce r i d e s ( MCT) i s co n si d e r e d beneficial t o reduce t he lym phedem a as, different from
736
syst em . Obesit y is anot her risk fact or for lym phedem a
and diet t herapy wit h a view t o weight loss seem s t o be useful for it s t reat m ent( 15).
CONCLUSI ON
Based o n t h i s l i t er at u r e r ev i ew , i t can b e concluded t hat , wit hin t he t herapeut ic m odalit ies used
for lym phedem a t reat m ent , CDT undoubt edly has t he
st rongest scient ific support . I t s applicat ion t oget her wit h PC has dem onst rat ed efficacy and new t echniques wit h
sat isfact or y r esult s ar e being st udied, such as HVES and laser t herapy. Com bined t echniques pr oduce t he
m o s t b e n e f i c i a l e f f e c t s a n d , d e p e n d i n g o n t h e p h y s i o p a t h o l o g y o f t h e l y m p h e d e m a , t h e
ph y siot h er apist sh ou ld select t h e best com bin at ion ,
based on a det ailed assessm ent of individual cases.
REFERENCES
1 . Gu i r r o E, Gu i r r o R. Fi si o t e r a p i a D e r m a t o - f u n ci o n a l : fundam ent os, r ecur sos, pat ologias. São Paulo ( SP) : Manole; 2 0 0 2 .
2. Cam ar go MC, Mar x AG. Reabilit ação Física no Câncer de Mam a. São Paulo ( SP) : Roca; 2000.
3. Kisner C, Colby LA. Exer cícios Ter apêut icos Fundam ent os e Técnicas. São Paulo ( SP) : Manole; 2 0 0 5 .
4 . Bor ges FS. Der m at o- funcional: Modalidades Ter apêut icas n as Disf u n ções Est ét icas. São Pau lo ( SP) : Ph or t e; 2 0 0 6 . 5 . Pa n o b i a n c o M S , M a m e d e M V. Co m p l i c a ç õ e s e i n t e r co r r ê n ci a s a sso ci a d a s a o e d e m a d e b r a ço n o s t r ê s p r i m e i r o s m e s e s p ó s m a s t e c t o m i a . Re v La t i n o - a m En f er m ag em 2 0 0 2 ; 1 0 ( 4 ) : 5 4 4 - 5 1 .
6. Ander sen L, Hoj r is I , Er landsen M, Ander sen J. Tr eat m ent of breast - cancer- relat ed- lym phedem a w it h or w it hout m anual ly m ph at ic drain age. A r an dom ized st u dy. Act a On col 2 0 0 0 ; 3 9 ( 3 ) : 3 9 9 - 4 0 5 .
7 . Ga r c i a LB , Gu i r r o ECO, Mo n t e b e l l o MI L. Ef e i t o s d a est i m u l ação el ét r i ca d e al t a v o l t ag em n o l i n f ed em a p ó s-m ast ect os-m ia bilat er al: est udo de caso. Fisiot er Pesqui 2007; 1 4 ( 1 ) : 6 7 - 7 1 .
8 . Meir elles MCCC, Mam ede MV, Sou za L, Pan obian co M. S. Av al i ação d e t écn i cas f i si o t er ap êu t i cas n o t r at am en t o d o l i n f ed em a p ó s- ci r u r g i a d e m am a em m u l h er es. Rev Br as Fi si o t er 2 0 0 6 ; 1 0 ( 4 ) : 3 9 3 - 9 .
9 . Vi g n es S, Po r ch er R, Ar r a u l t M, D u p u y A. Lo n g - t er m m an ag em en t o f b r east can cer - r el at ed l y m p h ed em a af t er i n t en si v e d eco n g est i v e p h y si o t h er ap y. Br east Can cer Res Tr ea t 2 0 0 7 ; 1 0 1 : 2 8 5 - 9 0 .
1 0 . Gar cia LB, Gu ir r o ECO. Ef eit os da Est im u lação de Alt a Volt agem no Linfedem a Pós- m ast ect om ia. Rev Br as Fisiot er 2 0 0 5 ; 9 ( 2 ) : 2 4 3 - 8 .
11. Ham m er JB, Flem ing MD: Ly m phedem a t her apy r educes t he volum e of edem a and pain in pat ient s wit h breast cancer. An n als Su r g On col 2 0 0 7 ; 1 4 ( 6 ) : 1 9 0 4 - 8 .
12. Godoy JMP, Godoy MFG. Drenagem linfát ica m anual: nov o con ceit o. J Vasc Br 2 0 0 4 ; 3 ( 1 ) : 7 7 - 8 0 .
13. Tsai H, Hung H, Yang J, Huang C, Tsauo J. Could Kinesio t ape r eplace t he bandage in decongest iv e ly m phat ic t her apy for breast - cancer- relat ed lym phedem a? A pilot st udy. Support Car e Cancer 2009. [ Epub ahead of pr int ]
1 4 . Kar adibak D, Yav u zsen T, SAYDAM S: Pr ospect ive Tr ial
of I nt ensive Decongest ive Physiot her apy for Upper Ext r em it y Ly m ph edem a. J Su r g On col 2 0 0 8 ; 9 7 : 5 7 2 – 7 .
15. Oliv eir a J, César TB. I nfluência da fisiot er apia com plex a d e sco n g e st i v a a sso ci a d a à i n g e st ã o d e t r i g l i ce r íd e o s d e cadeia m édia no t rat am ent o do linfedem a de m em bro superior. Rev Br as Fisiot 2 0 0 8 ; 1 2 ( 1 ) : 3 1 - 6 .
16. Mckenzie DC, Kalda AL. Effect of upper ext rem it y exercise on secondar y ly m phedem a in br east cancer pat ient s: a pilot st u dy. Jou r n al of Clin ical On cology 2 0 0 3 ; 2 1 ( 3 ) : 4 6 3 - 6 . 17. Rezende LF, Fr anco RL, Rezende MF, Belet t i PO, Moraes SS, Gu r g el MSC. Tw o ex er ci se sch em es i n p o st o p er at i v e br east cancer : com par ison of effect s on shoulder m ov em ent an d ly m ph at ic dist u r ban ce. Tu m or i 2 0 0 6 ; 9 2 : 5 5 - 6 1 . 18. Koul R, Dufan T, Russell C, Guenther W, Nugent Z, Sun X, et al. Efficacy of com plete decongestive therapy and m anual lym phatic drainage on treatm ent-related lym phedem a im breast cancer. I nt J Radiat Oncol Biol Phys 2007; 67( 3) : 841- 6.
19. Szuba A, Achalu R, Rockson SG. Decongest ive lym phat ic t h e r a p y f o r p a t i e n t s w i t h b r e a s t c a r c i n o m a - a s s o c i a t e d ly m ph edem a. Am Can cer Soc 2 0 0 2 ; 9 5 ( 1 1 ) .
2 0 . Din i D, Del Mast r o L, Gozza A, Lion et t o R, Gar r on e O, Forno G, et al. The role of pneum at ic com pression in t reat m ent of p ost m ast ect om y ly m p h ed em a. A r an d om ized p h ase I I I st u d y. An n On col 1 9 9 8 ; 9 : 1 8 7 - 1 9 0 .
21. Leduc O, Leduc A, Bourgeois P, Belgrado JP. The physical t r eat m ent of upper lim b edem a. Cancer 1998; 83( 12 Suppl Am e r i ca n ) : 2 8 3 5 - 9 .
2 2 . Al o n g G. H i g h Vo l t a g e St i m u l a t i o n : A Mo n o g r a p h . Ch at t an ooga, Ten n ., Ch at t an ooga Cor por at ion ; 1 9 8 4 . 2 3 . Gar cia LB, Gu ir r o ECO, Mon t eb ello MI L. Av aliação d e diferent es recursos fisiot erapêut icos no cont role do linfedem a p ós- m ast ect om ia. Rev Br as Mast ol 2 0 0 5 ; 1 5 ( 2 ) : 6 4 - 7 0 . 24. Carat i CJ, Anderson SN, Gannon BJ, Piller NB. Treat m ent of post m ast ect om y plym phedem a w it h low- level laser t herapy. Ca n cer 2 0 0 3 ; 9 8 ( 6 ) : 1 1 1 4 - 2 2 .
2 5 . Mosely AL, Car at i CJ, Piller NB. A sy st em at ic r ev iew of co m m o n co n se r v a t i v e t h e r a p i e s f o r a r m l y m p h o e d e m a seco n d ar y t o b r east can cer t r eat m en t . An n On co l 2 0 0 7 ; 1 8 : 6 3 9 - 4 6.
2 6 . Br en n an MJ, Miller LT. Ov er v iew of Tr eat m en t Op t ion s an d Rev iew of t h e Cu r r en t Role an d Use of Com p r ession Ga r m e n t s , I n t e r m i t t e n t Pu m p s , a n d Ex e r c i s e i n t h e Man ag em en t of Ly m p h ed em a. Can cer 1 9 9 8 ; 8 3 ( 1 2 Su p p l Am e r i ca n ) : 2 8 2 1 - 7 .
Recebido em : 30.7.2008 Aprovado em : 14.5.2009
Rev Lat ino- am Enferm agem 2009 set em bro- out ubro; 17( 5) : 730- 6 w w w .eer p.usp.br / r lae
Physiotherapy treatm ents for breast cancer-related…
