Top

07-12-2017 | Breast cancer | Article

Low level laser therapy (Photobiomodulation therapy) for breast cancer-related lymphedema: a systematic review

Journal: BMC Cancer

Authors: G. David Baxter, Lizhou Liu, Simone Petrich, Angela Spontelli Gisselman, Cathy Chapple, Juanita J. Anders, Steve Tumilty

Publisher: BioMed Central

Abstract

Background

Breast cancer related lymphedema (BCRL) is a prevalent complication secondary to cancer treatments which significantly impacts the physical and psychological health of breast cancer survivors. Previous research shows increasing use of low level laser therapy (LLLT), now commonly referred to as photobiomodulation (PBM) therapy, for BCRL. This systematic review evaluated the effectiveness of LLLT (PBM) in the management of BCRL.

Methods

Clinical trials were searched in PubMed, AMED, Web of Science, and China National Knowledge Infrastructure up to November 2016. Two reviewers independently assessed the methodological quality and adequacy of LLLT (PBM) in these clinical trials. Primary outcome measures were limb circumference/volume, and secondary outcomes included pain intensity and range of motion. Because data were clinically heterogeneous, best evidence synthesis was performed.

Results

Eleven clinical trials were identified, of which seven randomized controlled trials (RCTs) were chosen for analysis. Overall, the methodological quality of included RCTs was high, whereas the reporting of treatment parameters was poor. Results indicated that there is strong evidence (three high quality trials) showing LLLT (PBM) was more effective than sham treatment for limb circumference/volume reduction at a short-term follow-up. There is moderate evidence (one high quality trial) indicating that LLLT (PBM) was more effective than sham laser for short-term pain relief, and limited evidence (one low quality trial) that LLLT (PBM) was more effective than no treatment for decreasing limb swelling at short-term follow-up.

Conclusions

Based upon the current systematic review, LLLT (PBM) may be considered an effective treatment approach for women with BCRL. Due to the limited numbers of published trials available, there is a clear need for well-designed high-quality trials in this area. The optimal treatment parameters for clinical application have yet to be elucidated.

Pinto AC, de Azambuja E. Improving quality of life after breast cancer: dealing with symptoms. Maturitas. 2011;70(4):343–8.CrossRefPubMed

The New Zealand Breast Cancer Foundation Breast Cancer Overview. http://nzbcf.org.nz/BREASTCANCER/Overview/BreastCancerinNZ/Fastfacts.aspx. Accessed 01 Nov 2016.

DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500–15.CrossRefPubMed

Asim M, Cham A, Banerjee S, Nancekivell R, Dutu G, McBride C, Cavanagh S, Lawrenson R, Campbell I. Difficulties with defining lymphoedema after axillary dissection for breast cancer. NZ Med J. 2012;125(1351):29–39.

Morrell RM, Halyard MY, Schild SE, Ali MS, Gunderson LL, Pockaj BA. Breast cancer-related lymphedema. Mayo Clin Proc. 2005;80(11):1480–4.CrossRefPubMed

Ridner SH, Dietrich MS, Kidd N. Breast cancer treatment-related lymphedema self-care: education, practices, symptoms, and quality of life. Support Care Cancer. 2011;19(5):631–7.CrossRefPubMed

Park JE, Jang HJ, Seo KS. Quality of life, upper extremity function and the effect of lymphedema treatment in breast cancer related lymphedema patients. Ann Rehabil Med. 2012;36(2):240–7.CrossRefPubMedPubMedCentral

Penha TR, Botter B, Heuts EM, Voogd AC, von Meyenfeldt MF, van der Hulst RR. Quality of life in patients with breast cancer-related lymphedema and reconstructive breast surgery. J Reconstr Microsurg. 2016;32(6):484–90.CrossRefPubMed

International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 consensus document of the International Society of Lymphology. Lymphology. 2013;46(1):1–11.

10.

Oremus M, Dayes I, Walker K, Raina P. Systematic review: conservative treatments for secondary lymphedema. BMC Cancer. 2012;12:6.CrossRefPubMedPubMedCentral

11.

Nouri K, Jimenez GP, Harrison-Balestra C, Elgart GW. 585-nm pulsed dye laser in the treatment of surgical scars starting on the suture removal day. Dermatol Surg. 2003;29(1):65–73. discussion 73PubMed

12.

Lievens PC. The effect of a combined HeNe and i.R. Laser treatment on the regeneration of the lymphatic system during the process of wound healing. Lasers Med Sci. 1991;6(2):193–9.CrossRef

13.

Assis L, Moretti AI, Abrahao TB, de Souza HP, Hamblin MR, Parizotto NA. Low-level laser therapy (808 nm) contributes to muscle regeneration and prevents fibrosis in rat tibialis anterior muscle after cryolesion. Lasers Med Sci. 2013;28(3):947–55.CrossRefPubMed

14.

Jang DH, Song DH, Chang EJ, Jeon JY. Anti-inflammatory and lymphangiogenetic effects of low-level laser therapy on lymphedema in an experimental mouse tail model. Lasers Med Sci. 2016;31(2):289–96.CrossRefPubMed

15.

Lima MT E, Lima JG E, de Andrade MF, Bergmann A. Low-level laser therapy in secondary lymphedema after breast cancer: Systematic review. Lasers Med Sci. 2014;29(3):1289–95.CrossRef

16.

Chen CH, Tsai JL, Wang YH, Lee CL, Chen JK, Huang MH. Low-level laser irradiation promotes cell proliferation and mRNA expression of type I collagen and decorin in porcine Achilles tendon fibroblasts in vitro. J Orthop Res. 2009;27(5):646–50.CrossRefPubMed

17.

Gavish L, Perez L, Gertz SD. Low-level laser irradiation modulates matrix metalloproteinase activity and gene expression in porcine aortic smooth muscle cells. Lasers Surg Med. 2006;38(8):779–86.CrossRefPubMed

18.

Huang Y-Y, Chen ACH, Sharma SK, Wu Q, Hamblin MR. Comparison of cellular responses induced by low level light in different cell types. Proc SPIE. 2010;7552

19.

Kreisler M, Christoffers AB, Willershausen B, d'Hoedt B. Effect of low-level GaAlAs laser irradiation on the proliferation rate of human periodontal ligament fibroblasts: an in vitro study. J Clin Periodontol. 2003;30(4):353–8.CrossRefPubMed

20.

Peplow PV, Chung TY, Baxter GD. Laser photobiomodulation of wound healing: a review of experimental studies in mouse and rat animal models. Photomed Laser Surg. 2010;28(3):291–325.CrossRefPubMed

21.

Stadler I, Evans R, Kolb B, Naim JO, Narayan V, Buehner N, Lanzafame RJ. In Vitro effects of low-level laser irradiation at 660 nm on peripheral blood lymphocytes. Lasers Surg Med. 2000;27(3):255–61.CrossRefPubMed

22.

Stein A, Benayahu D, Maltz L, Oron U. Low-level laser irradiation promotes proliferation and differentiation of human osteoblasts in vitro. Photomed Laser Surg. 2005;23(2):161–6.CrossRefPubMed

23.

Tuby H, Maltz L, Oron U. Low-level laser irradiation (LLLI) promotes proliferation of mesenchymal and cardiac stem cells in culture. Lasers Surg Med. 2007;39(4):373–8.CrossRefPubMed

24.

Vinck EM, Cagnie BJ, Cornelissen MJ, Declercq HA, Cambier DC. Increased fibroblast proliferation induced by light emitting diode and low power laser irradiation. Lasers Med Sci. 2003;18(2):95–9.CrossRefPubMed

25.

Karu T: Ten lectures on basic science of laser phototherapy. Sweden: Graengesberg: Prima Books; 2007.

26.

Gavish L, Perez LS, Reissman P, Gertz SD. Irradiation with 780 nm diode laser attenuates inflammatory cytokines but upregulates nitric oxide in lipopolysaccharide-stimulated macrophages: implications for the prevention of aneurysm progression. Lasers Surg Med. 2008;40(5):371–8.CrossRefPubMed

27.

Hou JF, Zhang H, Yuan X, Li J, Wei YJ, SS H. In Vitro effects of low-level laser irradiation for bone marrow mesenchymal stem cells: proliferation, growth factors secretion and myogenic differentiation. Lasers Surg Med. 2008;40(10):726–33.CrossRefPubMed

28.

Rocha Junior AM, Vieira BJ, de Andrade LC, Aarestrup FM. Low-level laser therapy increases transforming growth factor-beta2 expression and induces apoptosis of epithelial cells during the tissue repair process. Photomed Laser Surg. 2009;27(2):303–7.CrossRefPubMed

29.

Saygun I, Karacay S, Serdar M, Ural AU, Sencimen M, Kurtis B. Effects of laser irradiation on the release of basic fibroblast growth factor (bFGF), insulin like growth factor-1 (IGF-1), and receptor of IGF-1 (IGFBP3) from gingival fibroblasts. Lasers Med Sci. 2008;23(2):211–5.CrossRefPubMed

30.

Gao X, Xing D. Molecular mechanisms of cell proliferation induced by low power laser irradiation. J Biomed Sci. 2009;16:4.CrossRefPubMedPubMedCentral

31.

Hawkins DH, Abrahamse H. The role of laser fluence in cell viability, proliferation, and membrane integrity of wounded human skin fibroblasts following helium-neon laser irradiation. Lasers Surg Med. 2006;38(1):74–83.CrossRefPubMed

32.

Karu T. Primary and secondary mechanisms of action of visible to near-IR radiation on cells. J Photochem Photobiol B. 1999;49(1):1–17.CrossRefPubMed

33.

Lievens P: The Influence of laser irradiation on the motricity of lymphatical system and on the wound healing process. In: International Congress on Laser in Medicine and Surgery: 26–28 June 1985; Bologna; 1985: 171–174.

34.

Inoue K, Nishioka J, Hukuda S. Altered lymphocyte proliferation by low dosage laser irradiation. Clin Exp Rheumatol. 1989;7(5):521–3.PubMed

35.

Horvath Z, et al. Possible ab-initio explanation of laser "biostimulation" effects. Laser applications in medicine and surgery. Edited G. Galetti et al. Proc 3rd World Congr - Intl Soc Low Power Laser Appln in Medicine. 1992. p. 57.

36.

Omar MT, Shaheen AA, Zafar H. A systematic review of the effect of low-level laser therapy in the management of breast cancer-related lymphedema. Support Care Cancer. 2012;20(11):2977–84.CrossRefPubMed

37.

Smoot B, Chiavola-Larson L, Lee J, Manibusan H, Allen DD. Effect of low-level laser therapy on pain and swelling in women with breast cancer-related lymphedema: a systematic review and meta-analysis. J Cancer Surviv. 2015;9(2):287–304.CrossRefPubMed

38.

Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, Knipschild PG. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 1998;51(12):1235–41.CrossRefPubMed

39.

Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull. 1971;76(5):378–82.CrossRef

40.

Moseley AM, Herbert RD, Sherrington C, Maher CG. Evidence for physiotherapy practice: a survey of the physiotherapy evidence database (PEDro). Aust J Physiother. 2002;48(1):43–9.CrossRefPubMed

41.

Karki A, Anttila H, Tasmuth T, Rautakorpi UM. Lymphoedema therapy in breast cancer patients: a systematic review on effectiveness and a survey of current practices and costs in Finland. Acta Oncol. 2009;48(6):850–9.CrossRefPubMed

42.

van Tulder M, Furlan A, Bombardier C, Bouter L. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine (Phila Pa 1976). 2003;28(12):1290–9.

43.

Recommended treatment doses for low level laser therapy. http://waltza.co.za/documentation-links/recommendations/dosage-recommendations/. Accessed 01 Nov 2016.

44.

Piller NB, Thelander A. Treating chronic post-mastectomy lymphoedema with low level laser therapy: a cost effective strategy to reduce severity and improve the quality of survival. Laser Ther. 1995;7(4):163–8.CrossRef

45.

Piller NB, Thelander A. Treatment of chronic postmastectomy lymphedema with low level laser therapy: a 2.5 year follow-up. Lymphology. 1998;31(2):74–86.PubMed

46.

Carati CJ, Anderson SN, Gannon BJ, Piller NB. Treatment of postmastectomy lymphedema with low-level laser therapy: a double blind, placebo-controlled trial. Cancer. 2003;98(6):1114–22.CrossRefPubMed

47.

Kaviani A, Fateh M, Yousefi-Nooraie R, Alinagi-Zadeh MR, Ataie-Fashtami L. Low-level laser therapy in management of postmastectomy lymphedema. Lasers Med Sci. 2006;21(2):90–4.CrossRefPubMed

48.

Omar MTA, Ebid AA, El Morsy AM. Treatment of post-mastectomy lymphedema with laser therapy: double blind placebo control randomized study. J Surg Res. 2011;165(1):82–90.CrossRef

49.

Ridner SH, Poage-Hooper E, Kanar C, Doersam JK, Bond SM, Dietrich MS. A pilot randomized trial evaluating low-level laser therapy as an alternative treatment to manual lymphatic drainage for breast cancer-related lymphedema. Oncol Nurs Forum. 2013;40(4):383–93.CrossRefPubMed

50.

Kozanoglu E, Basaran S, Paydas S, Sarpel T. Efficacy of pneumatic compression and low-level laser therapy in the treatment of postmastectomy lymphoedema: a randomized controlled trial. Clin Rehabil. 2009;23(2):117–24.CrossRefPubMed

51.

Maiya A, Olivia E, Dibya A. Effect of low energy laser therapy in the management of post- mastectomy lymphoedema. Physiotherapy Singapore. 2008;11(1):2–5.

52.

Lau RW, Cheing GL. Managing postmastectomy lymphedema with low-level laser therapy. Photomed Laser Surg. 2009;27(5):763–9.CrossRefPubMed

53.

World Association of Laser Therapy (WALT). Consensus agreement on the design and conduct of clinical studies with low-level laser therapy and light therapy for musculoskeletal pain and disorders. Photomed Laser Surg. 2006;24(6):761–2.

54.

Mayrovitz HN, Davey S. Changes in tissue water and indentation resistance of lymphedematous limbs accompanying low level laser therapy (LLLT) of fibrotic skin. Lymphology. 2011;44(4):168–77.PubMed

55.

Dirican A, Andacoglu O, Johnson R, McGuire K, Mager L, Soran A. The short-term effects of low-level laser therapy in the management of breast-cancer-related lymphedema. Support Care Cancer. 2011;19(5):685–90.CrossRefPubMed

56.

Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:10.CrossRefPubMedPubMedCentral

57.

Moseley AL, Carati CJ, Piller NB. A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. Ann Oncol. 2007;18(4):639–46.CrossRefPubMed

58.

Stout NL, Pfalzer LA, Springer B, Levy E, McGarvey CL, Danoff JV, Gerber LH, Soballe PW. Breast cancer-related lymphedema: comparing direct costs of a prospective surveillance model and a traditional model of care. Phys Ther. 2012;92(1):152–63.CrossRefPubMed

59.

Tumilty S, Munn J, McDonough S, Hurley DA, Basford JR, Baxter GD. Low level laser treatment of tendinopathy: a systematic review with meta-analysis. Photomed Laser Surg. 2010;28(1):3–16.CrossRefPubMed

60.

Law D, McDonough S, Bleakley C, Baxter GD, Tumilty S. Laser acupuncture for treating musculoskeletal pain: a systematic review with meta-analysis. J Acupunct Meridian Stud. 2015;8(1):2–16.CrossRefPubMed

61.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9. w264CrossRefPubMed