Advances in the prevention and treatment of breast cancer-related lymphedema

Abstract

Purpose: Breast cancer-related lymphedema (BCRL) represents a lifelong risk for breast cancer survivors and once acquired becomes a lifelong burden. This review summarizes current BCRL prevention and treatment strategies.

Findings: Risk factors for BCRL have been extensively studied and their identification has affected breast cancer treatment practice, with sentinel lymph node removal now standard of care for patients with early stage breast cancer without sentinel lymph node metastases. Early surveillance and timely management aim to reduce BCRL incidence and progression, and are further facilitated by patient education, which many breast cancer survivors report not having adequately received. Surgical approaches to BCRL prevention include axillary reverse mapping, lymphatic microsurgical preventative healing (LYMPHA) and Simplified LYMPHA (SLYMPHA). Complete decongestive therapy (CDT) remains the standard of care for patients with BCRL. Among CDT components, facilitating manual lymphatic drainage (MLD) using indocyanine green fluorescence lymphography has been proposed. Intermittent pneumatic compression, nonpneumatic active compression devices, and low-level laser therapy appear promising in lymphedema management. Reconstructive microsurgical techniques such as lymphovenous anastomosis and vascular lymph node transfer are growing surgical considerations for patients as well as liposuction-based procedures for addressing fatty fibrosis formation from chronic lymphedema. Long-term self-management adherence remains problematic, and lack of diagnosis and measurement consensus precludes a comparison of outcomes. Currently, no pharmacological approaches have proven successful.

Conclusion: Progress in prevention and treatment of BCRL continues, requiring advances in early diagnosis, patient education, expert consensus and novel treatments designed for lymphatic rehabilitation following insults.

Keywords: Breast cancer; Breast cancer lymphedema; Indocyanine green; Lymphedema; Manual lymphatic drainage; Optical imaging.

Fig. 1

Major approaches to BCRL management. CDT complete decongestive therapy, IPC intermittent pneumatic compression, LLLT low-level laser therapy, LVA lymphovenous anastomosis, MLD manual lymphatic drainage, SAPL suction-assisted protein lipectomy, VLNT vascularized lymph node transfer

Fig. 2

Reported outcomes in patients with BCRL after VLNT surgery. From a systematic review by Ozturk et al. [119]