Intensive complete decongestive physiotherapy for cancer-related upper-limb lymphedema: 11 days achieved greater volume reduction than 4

•We determine the optimal duration for lymphedema-volume reduction during this phase.•Lymphedema-volume reduction was superior after 11 days of treatment than 4.•Surgery to lymphedema-onset interval > 2 years was the only factor associated with 4 days achieving ≥ 75% of the total lymphedema-volume reduction.

BackgroundUpper-limb lymphedema (ULL) occurs in 15-20% of women after breast-cancer treatment. Its intensive therapy relies on complete (complex) decongestive physiotherapy (CDP), whose duration is not well-established.ObjectiveDetermine optimal intensive-phase CDP duration for lymphedema-volume reduction and factors predicting its success, with the hope of halving it from 11 to 4 days.MethodsAll patients with ULL (08/2011-06/2012) after breast-cancer treatment referred to our Department of Lymphology in a rehabilitation facility for 11 days of CDP were eligible. Lymphedema volume was calculated using the truncated-cone formula. Volume reduction considered clinically relevant after 4 days was defined as ≥ 75% of the total reduction obtained after 11 days.ResultsWe included 129 women (median age: 64 (range: 42-88) years). Mean (sd) lymphedema volume was 907 (558) ml at CDP onset, decreased to 712 (428) ml after 4 days (vs. onset, P < .0001) and 606 (341) ml after 11 days (vs. 4, P < .0001), corresponding to 33% total lymphedema-volume reduction. For all patients, 4 days of CDP achieved 63% (sd 40%) of that total reduction, with ≥ 75% for 50 (39%) patients. Surgery-to-lymphedema-onset interval > 2 years was the only factor significantly associated with 4 days achieving ≥ 75% of the total lymphedema-volume reduction.ConclusionIntensive phase CDP for 11 days obtained significantly more volume reduction of breast cancer-related ULL than 4.