Photobiomodulation Associated or Not with Other Therapeutic Techniques in the Treatment of Post-Breast Cancer Lymphedema: Literature Systematic Review

Reis, Larissa Silva dos; Silva, Tarcísio Souza da; Januário, Priscila Godoy

doi:10.32635/2176-9745.RBC.2025v71n3.5249

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Literature Review • Rev. Bras. Cancerol. 71 (3) • 2025 • https://doi.org/10.32635/2176-9745.RBC.2025v71n3.5249EN linkcopy

Photobiomodulation Associated or Not with Other Therapeutic Techniques in the Treatment of Post-Breast Cancer Lymphedema: Literature Systematic Review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction: Breast cancer is the most common neoplasm among women in Brazil. Despite the various therapeutic approaches, surgical treatment is still indicated in many cases and usually includes a sentinel lymph node biopsy or axillary dissection. These techniques are associated with an increased risk of developing lymphedema. As a form of treatment for this chronic condition, photobiomodulation (PBM) has stood out for its effects in reducing inflammation, edema, and fibrosis, favoring the recovery of patients.

Objective: To systematize the effects of PBM as a complementary therapy associated or not with other therapeutic techniques in post-breast cancer lymphedema.

Method: Systematic review carried out on PubMed/MEDLINE, ScienceDirect, PEDro, BVS, and SciELO databases, using descriptors in Portuguese and English. Randomized clinical trials were included, without restrictions on language or year of publication.

Results: Ten articles were included out of a total of 227 (all randomized clinical trials, PEDro score 6-9). Isolated PBM demonstrated efficacy in reducing limb volume, improving pain and functionality, with more evident effects in the first months and possible long-term maintenance. When associated with other therapies, the results were enhanced.

Conclusion: PBM has shown to be a promising complementary approach for the management of post-breast cancer lymphedema, with beneficial results on symptoms. Further research is needed to standardize protocols that favor reproducibility and expand its application in clinical practice.

Key words:
Breast Cancer Lymphedema; Mastectomy; Low-Level Light Therapy; Systematic Review

Author/Year	Sample	PEDro scale	Parameters	Intervention protocol	Results
Kaviani³² (2006) Clinical trial	EG: 4 CG: 4 Total: 8	8/10	1.5 J/cm² 890 nm 3,000 Hz	EG: Application of LLLT in 5 points at the axillary area, 3x/week for 3 weeks, repeating after 8 weeks (18 sessions) CG: Received simulated irradiation under double-blinding conditions	EG presented a greater reduction in circumference every week, except on the 22nd. Moreover, there was pain reduction and greater treatment adherence in EG. Regarding post-session pain compared to pre-treatment, results were superior to the placebos in most assessments, except in weeks 3 and 9
Carati, et al.³³ (2003) Clinical trial	EG: 33 CG: 28 Total: 61	8/10	1.5 J/cm² 904 nm 800 Hz	EG: 2 LLLT (active laser) cycles, separated by an 8-week break CG: 1 LLLT (placebo) cycle, followed by an 8-week break, then 1 active LLLT cycle Sessions: 9 sessions per cycle (3x/week, for 3 weeks) for both groups Application: 17 axillary points (1 min/point) Crossovers: After the first cycle, 11 participants of the placebo group were moved to the active group	Significant reduction in the limb volume occurred after 2 LLLT cycles (31% of patients had a reduction > 200 ml in 2-3 months). There was no improvement with placebo or 1 laser cycle. The extracellular fluid and tonometry improved after 3 months, but there was no gain in the range of motion
Kozanoglu, et al.³⁴ (2009) Clinical trial	EG: 23 CG: 24 Total: 47	7/10	1.5 J/cm² 904 nm 2,800 Hz	EG: LLLT with sessions 3x/week, for 4 weeks (12 sessions), for 20 minutes. Application at 3 points in the antecubital fossa and 7 in the armpit CG: IPC (60 mmHg), for 2 hours, 5x/week, for 4 weeks Both groups: daily upper limb exercises (active, range of motion, elevation, and pumping), hygiene and skin care	Both groups decreased limb circumference in the first 6 months, but only EG maintained the effect by the end of 12 months. Pain on movement decreased in both groups at first, but only EG sustained improvement upon follow-up. Grip strength increased similarly in both groups with no significant differences
Storz, et al.³⁵ (2016) Clinical trial	EG: 20 CG: 20 Total: 40	8/10	4.9 cm² 980 nm	EG: LLLT sessions 2x/week, for 4 weeks, for 10 minutes. Application points throughout the whole armpit CG: Placebo LLLT	EG and CG presented similar pain reduction at 50%. For quality of life (MQOL-R and MMSQ), LLLT was slightly superior. Grip strength increased in both groups, being greater in EG after 2 months. Limb circumference was reduced in the placebo group, with no statistical significance
Kozanoglu, et al.³⁶ (2022) Clinical trial	EG: 21 CG: 21 Total: 42	6/10	1.5 J/cm² 904 nm 2,800 Hz	EG (IPC + LLLT): 5 laser sessions a week for 4 weeks, for 20 minutes. Laser was applied at 3 points in the antecubital fossa and at 7 points in the armpit CG (isolated IPC): device (MJS Healthcare Ltd., United Kingdom) generating a 60-mmHg pressure Both groups received 5 IPC sessions a week for 4 weeks (totaling 20 sessions), and each session lasted 60 minutes	There was significant improvement in the limb circumference and grip strength in EG and CG, especially in the 3rd month for EG. Pain on the resting shoulder did not present differences between groups but was lighter in the EG group at the 6th and 12th months. Pain upon movement was reduced only in EG, with a significant difference on pre-treatment assessments and follow-up
Yilmaz SS; Ayhan FF.³⁷ (2023) Clinical trial	G1:15 G2:15 G3:15 Total: 45	6/10	1.5 J/cm² 808 nm 30 mW/cm²	G1 (MLD): Received skin care, lymphatic drainage, compressive banding, and exercise G2 (kinesio-taping): Skin care, kinesio-taping, compressive banding, and exercise G3 (LLLT): Applied at 12 points in the axillary region and 8 points in the cubital fossa, 1 minute in each point, totaling 20 minutes + compressive banding + skin care and exercise	G2 was superior to G1 and G3 in reducing limb volume. There was significant improvement in upper limb function (Quick-DASH) for G2 and G3 at the end of treatment and in the 4th and 12th weeks after the treatment. As to the MLD group, this improvement occurred only at the end of treatment. Quality of life (LYMQOL-arm) was better in G2 at all times, at G1 at the end of treatment, and after 4 weeks, whereas G3 had significant improvement at the end of treatment
Ridner, Sheila H.³⁸ et al. (2013) Clinical trial	G1: 15 G2: 16 G3: 15 Total: 46	6/10	904 nm	G1: LLLT application for 20-30 seconds at each point, in 20-minute sessions G2: MLD following international guidelines (Földi³⁹). A standard number of touches was used in each anatomical location. Each session lasted around 40 minutes G3: 20 minutes LLLT + 20 minutes MLD. At the end of each session, all groups received compressive banding	All groups presented significant reductions in arm circumference and volume, with no statistically significant differences between groups. LLLT (in isolation or combined with MLD) showed a tendency to produce greater effects in comparison with isolated MLD
Omar, Ebid and Morsy⁴⁰ (2011) Clinical trial	EG: 25 CG: 25 Total: 50	9/10	1.5 J/cm² 904 nm 2,800 Hz	EG: LLLT, 3x/week, for 20 minutes, for 36 sessions, with application at 3 points of the antecubital fossa and 7 points of the armpit CG: Placebo LLLT	EG overcame placebo in reducing limb circumference, improving range of motion (flexion/abduction), and grip strength, with significant effects in 8 and 12 weeks
Lau; Cheing⁴¹ (2009) Clinical trial	EG: 11 CG: 10 Total: 21	7/10	2 J/cm² 905 nm 1 to 1,500 Hz	EG: 1 LLLT cycle, 3x/week, for 4 weeks, in the axillary area of the affected side, for 20 minutes CG: Placebo LLLT	LLLT significantly reduced arm volume (16% at the end of treatment and 28% at follow-up) and tissue softening. There were progressive improvements in upper limb function (DASH score), with no differences between groups, however
Kilmartin, Laurie et al.⁴² (2020) Clinical trial	EG: 9 CG: 6 Total: 15	6/10	1.5 J/cm² 904 nm	EG: LLLT+ CDT: LLLT was applied at 10 points in the armpit and chest wall for 1 minute each, in 8 to 16 sessions, for one 4-week cycle. Application: 10 areas in the armpit and part of the chest wall of the affected side CG: laser (placebo) + CDT	LLLT reduced symptoms of impaired mobility (44.4% vs. 33.3%), improved sadness (73% to 11%), and negative self-perception (36% to 0%). Moreover, EG (55.6%) reported fewer lymphedema-related symptoms than placebo 12 months after the intervention. There was no significant impact on limb volume or liquid accumulation

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Instituto Nacional de Câncer Rua Marquês de Pombal, 125 - 2º andar, Centro , CEP 20230-240, Tel.: +55 21 3207-6132 - Rio de Janeiro - RJ - Brazil
E-mail: rbc@inca.gov.br

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[TFN2] Captions: EG: experimental group; CG: control group/placebo; LLLT: Low-level laser therapy; MLD: manual lymphatic drainage; CDT: complex decongestive therapy; IPC: intermittent pneumatic compression; J/cm²: Joules per square centimeter; nm: Nanometer; Hz: hertz; mW/cm²: milliwatts per square centimeter; MQOL-R: McGill Quality of Life Questionnaire-Revised; MMSQ: Mini-Mental State Questionnaire; DASH = Disabilities of the Arm, Shoulder and Hand; LYMQOL-arm: lymphedema quality of life – arm.