Effects of Extracorporeal Shockwave Therapy on Improvements in Lymphedema, Quality of Life, and Fibrous Tissue in Breast

Lymphedema is a chronic disease caused by damage to the lymphatic drainage system, resulting in protein accumulation, swelling, chronic inflammation, and fibrosis in tissues. Secondary lymphedema is caused by tumors of the lymph nodes, lymph node dissection, radiotherapy, trauma, or infection. To promote lymph flow, complex physical therapy includes skincare, lymphatic drainage, compression tools, and exercise. The Extracorporeal shockwave therapy (ESWT) that is presented in this article is a recently developed non-invasive treatment approach that activates vascular endothelial growth factor (VEGF) and fibroblast, thereby promoting lymphatic neovascularization. Consequently, the primary aim of this study is to evaluate the effects of ESWT on the improvements of lymphedema, quality of life, and fibrous tissue in patients with stage 2 lymphedema. Female patients diagnosed with breast cancer by an oncology department and treated for lymphedema at an outpatient rehabilitation medical center were the subjects of this prospective study. The participants in this study were lymphedema patients in stage 2 who had firmness in their forearms and patients having a circumference difference between arms of more than 2 cm and a volume difference of more than 200 mL. The ESWT and control groups were randomly allocated to a total of 30 patients. Extracorporeal shockwaves were used to treat the ESWFT group, which were generated using an electromagnetic type Dornier AR2 device. At a strength of 0.056–0.068 mJ/mm2, 1,000 times for the most fibrotic area and 1,500 times for the cubital lymph node and forearm area were performed twice a week for three weeks, for a total of six times. Both groups received extensive physical treatment, including manual lymphatic massage, specific non-elastic bandage therapy, lymphatic drainage exercises, and skincare. This research included several assessments, beginning with that every patient was evaluated before treatment and three weeks after the treatment. The subjective pain level was measured...

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