Treatment of upper limb lymphedema with low-level laser: a systematic review

Monteiro, Silvia Elizate; Resende, Lilian Valim; Felicíssimo, Mônica Faria; Araújo, Angélica Rodrigues de; Vaz, Camila Teixeira

doi:10.1590/0103-5150.027.004.AR01

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Review articles • Fisioter. mov. 27 (4) • Oct-Dec 2014 • https://doi.org/10.1590/0103-5150.027.004.AR01 copy

Treatment of upper limb lymphedema with low-level laser: a systematic review

Laser de baixa potência no tratamento do linfedema de membro superior: revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction

Low-level lasers have been suggested as a complement to lymphedema treatment. However, this therapy’s mechanism of action and its effects are poorly understood up to the present.

Objective

To conduct a systematic literature review to analyze the effects of low-level laser in the treatment of upper-limb lymphedema in women submitted to breast cancer surgery.

Material and methods

Randomized clinical trials were included, in Portuguese, English and Spanish, from January 1990 to July 2013. The article search was carried out in the Pubmed, Lilacs and PEDro electronic databases, with the following descriptors:Terapia a Laser de Baixa Intensidade, Linfedema, Câncer de Mama, Low-level laser therapy, Lymphedema, Breast Neoplasms and also through a manual search.

Results and discussion

Low-level lasers have been used for treating several acute and chronic conditions. However, its application for managing post breast cancer surgery is still recent, often based on empirical evidence. Treating upper-limb lymphedema with low-level laser presented positive results, with reduction in the circumference or volume of the affected limb.

Conclusion

More studies of high methodological quality are needed in order to better understand the mechanism of action of low-level laser on the lymphatic system and its effects on lymphedema treatement.

Low-level laser therapy; Lymphedema; Breast neoplasms

Database	Keywords
Pubmed and PEDro	1. low-level laser therapy
	2. low-level laser therapy AND breast neoplasms
	3. low-level laser therapy AND lymphedema
	4. low-level laser therapy AND breast neoplasms AND lymphedema

Lilacs	1. terapia a laser de baixa intensidade
	2. terapia a laser de baixa intensidade AND câncer de mama
	3. terapia a laser de baixa intensidade AND linfedema
	4. terapia a laser de baixa intensidade AND câncer de mama AND linfedema

Author (year)	Sample	Comparison groups	Main outcomes/Instruments	Main results
Carati et al. (2003)	61	1. Group 1: 1^stpart – placebo LLLT 3x/week, for 3 weeks; 2^nd part – active LLLT 3x/week, for 3 weeks. 2. Group 2: 1^st part – active LLLT 3 x/week, for 3 weeks; 2^nd part – active LLLT 3 x/week, for 3 weeks.	1. Volume/Perimeter of affected limb. 2. Pain and feeling of heaviness in affected limb/ Score 1 (no symptoms) to 10 (worst imaginable pain)	Two cycles of LLLT were significantly effective in reducing volume of affected limb in 31% of participants, 1 month or 3 months following treatment. There were no differences regarding other outcomes.
Kaviani et al. (2006)	11	1. Group 1: Placebo LLLT 3 x/week, for 3 weeks. After an 8-week interval, placebo LLLT protocol was repeated. 2. Group 2: Active LLLT 3 x/week, for 3 weeks. After an 8-week interval, active LLLT protocol was repeated.	1. Circumference/Perimeter of affected limb 2. Pain and heaviness sensation in affected limb/ Visual Analog Scale.	There was a significant reduction in affected limb circumference and pain in the group that received active LLLT. There was no difference regarding feeling of heaviness.
Lau & Cheing (2009)	21	1. Group 1: Placebo LLLT 3 x/week, for 4 weeks. 2. Group 2: Active LLLT 3 x/week, for 4 weeks.	1. Volume of affected limb/ Direct volumetry 2. Pain and difficulty carrying out activities/ Disabilities Arm, Shoulder and Hand (DASH), questionnaire.	There was a significant reduction in the volume of the affected limb at the end of treatment and in the follow-up in the active LLLT group. There were no differences for any of the other investigated outcomes.
Omar et al. (2011)	50	1. Group 1: Placebo LLLT 3 x/week, for 12 weeks. 2. Group 2: active LLLT 3 x/week, for 12 weeks.	1. Circumference/ Perimeter of affected limb.	There was a significant reduction in the circumference of the affected limb in the active LLLT group in the 8^th week
Ridner et al. (2013)	46	1.Group 1: manual lymphatic drainage for 40’ + compression bandages 2.Group 2: LLLT + compression bandages 3.Group 3: LLLT + manual lymphatic drainage for 20’	1. Volume of affected limb 2. Extracellular fluid 3. Psychological and physical symptoms 4.Quality of Life (QOL)	The volume and extracellular volume of affected limb, as well as feeling of heaviness in limb were reduced. There were no differences in the improvement of psychological and physical symptoms, or in QOL. Improved aspect of skin was reported only by groups that received LLLT.

Author (year)	Random Allocation	Concealed Allocation	Homogeneous Groups	Blind subjects	Blind therapists	Blind assessors	Measures obtained from at least 85% of cases	Intention-to-treat analysis	Between-group comparison	Means and standard deviations	Score
Carati et al (2003)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	9/10
Kaviani et al (2006)	Yes	No	Yes	Yes	Yes	No	No	No	Yes	No	5/10
Lau & Cheing (2009)	Yes	Yes	Yes	Yes	No	No	Yes	Yes	Yes	Yes	8/10
Omar et al (2011)	Yes	No	Yes	Yes	No	Yes	Yes	No	Yes	Yes	7/10
Ridner et al (2013)	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	6/10

Author (Year)	Protocol	Irradiated region	Wavelength (nm)	Energy density (J/cm²)	Time/session (min.)
Carati et al. (2003)	9 sess. 3 weeks, 3 times/week. 3-month follow-up	17 armpit points	904	1.5	17 (1 min. each point)
Kaviani et al. (2006)	18 sess. 3 weeks, 3 times/week. 8-week interval. Protocol repeated.	Arm and 5 armpit points	890	1.5	Not reported
Lau & Cheing, (2009)	12 sess. 4 weeks, 3 times/week. 4-week follow-up	Armpit	808 and 905	2	20
Omar et al. (2011)	36 sess. 12 weeks, 3 times/week.	3 cubital fossa points and 5 armpit points	904	1.5	20 (2 min. each point)
Ridner et al. (2013)	Not reported	Not reported	904	Not reported	20 (20 to 30 sec. on each point)

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