Extracorporeal Shockwave Therapy is an Effective Adjunctive Treatment for Late-Stage Breast Cancer-Related Lymphedema when Complex Decongestive Therapy is Not Enough

Abstract Purpose: Complex decongestive treatment (CDT) and extracorporeal shockwave therapy (ESWT) have been shown to be effective in the treatment of early-stage breast-cancer-related lymphedema (BCRL) but less so for later-stage. This study examined the effects of ESWT on late-stage BCRL (Stages IIb and III) as an adjunct treatment after prolonged CDT failed. Patients and Methods: 11 female patients with BCRL who had undergone at least 6 months of CDT monotherapy without measurable effects received ESWT 3 times a week for 12 weeks with concurrent CDT. Limb circumference and the thicknesses of the skin, subcutaneous tissue, and muscle layers were measured using a measuring tape and ultrasound, respectively, in the most edematous regions of both the forearm and upper arm. Results: After the addition of ESWT to CDT, the mean circumference, thickness of the skin layer, and the thickness of the subcutaneous tissue layer of the affected limb decreased significantly (p < 0.05), while the mean thickness of muscle on the affected limb increased slightly but not significantly (forearm, p = 0.348; upper arm, p = 0.100). On the unaffected limb, no significant changes were measured (p > 0.05). Conclusions: ESWT as an adjunct treatment to CDT monotherapy after a period of 6 months showed significant reductions in distal and proximal upper limb circumference, skin layer thickness, and subcutaneous tissue layer thickness in patients suffering from prolonged late stage (IIb and III) BCRL, suggesting that the combination therapy was effective on severe BCRL and fibrotic lesions that could not be effectively treated by CDT alone.