Effectiveness of fluoroscopy-guided manual lymph drainage for the treatment of breast cancer-related lymphoedema

Currently, almost all patients with breast cancer-related lymphedema (BCRL) receive manual lymph drainage (MLD) to treat the edema. Despite this worldwide application of MLD, different systematic reviews and meta-analyses conclude that there is no strong evidence about the effectiveness of lymph drainage to treat BCRL. Belgrado and colleagues developed a new and more efficient method of lymph drainage to improve lymph transport, i.e. fluoroscopy-guided MLD. Belgrado has already shown that MLD with relatively high pressure (vs lower pressure) is more effective to improve lymph transport, as well as gliding (vs no gliding). In this study, only the physiological effect after one session of fluoroscopy-guided MLD was investigated. Whether the application of different sessions of fluoroscopy-guided MLD as part of the intensive phase of Decongestive Lymphatic Therapy is clinically effective, has never been examined. Therefore, a randomised controlled trial will investigate the effect of fluoroscopy-guided MLD versus traditional MLD vs placebo MLD on several clinical parameters (primary: change in arm/hand volume and change in accumulation of fluid at level of the shoulder/trunk, and secondary: change in quality of life (QoL) and change in lymphedema-related functioning) in patients with BCRL. Other research objectives of this doctoral project are: 1) To compare five volumetric measurement methods in terms of reliability, time-efficiency, and clinical feasibility for assessing excessive arm volume in patients with BCRL: traditional volumetry with overflow, volumetry without overflow, inversed volumetry, opto-electronic volumetry and calculated volume based on circumferences. 2) To investigate and compare reliability of the MoistureMeterD® Compact device and the pitting test as clinical assessment tools for evaluating the water content and composition of edema, in patients BCRL. 3) To assess the clinimetric properties (validity, reliability and responsiveness) of the Dutch Lymph-ICF-UL questionnaire in patients with BCRL. Additionally, to translate the Dutch version of the Lymph-ICF-UL questionnaire into French, and to assess its clinimetric properties (validity and reliability) accordingly, in a cohort of French-speaking patients with BCRL. 4) To make a systematic review on the financial impact of BCRL treatment. Furthermore, to make a financial analysis of the direct costs related to BCRL and its sequelae, in a European setting. These five research aims will be investigated through nine different studies representing nine chapters.

Publication year:2020

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