Effect of Pulsed RF Energy on Postmastectomy Arm Lymphedema Harvey - PowerPoint PPT Presentation

Effect of Pulsed RF Energy on Postmastectomy Arm Lymphedema Harvey N. Mayrovitz Nancy Sims John Macdonald College of Medical Sciences Nova Southeastern University Ft. Lauderdale Florida Bioelectromagnetics Society Meeting - 2002

BEMS BUDDIES In Quebec Marco Markov Art Pilla

Lymphedema • High protein content edema secondary to node removal and/or radiation therapy • Occurs in 20-40% of postmastectomy w omen from months to years after surgery • Usually progressive if untreated - Fibrosis

Treatment Complex Decongestive Therapy (CDT) • Manual Lymph Drainage • Compression Bandaging • Exercise and Skin Care

Current Study Rationale • CDT promotes lymph drainage  Expands collateral channels  Provides alternative pathw ays • Pulsed RF (PRFT)  Increases skin blood flow (SBF) via  Vascular channel enlargement HYPOTHESIS PRFT affects lymph channels similarly to blood channels

Deep Pathw ays Normal Superficial

 “Substitutution” Pathw ays Takeover requires a “kick-start” Pulsed Pulsed  RF RF S to D

Objectives Pilot study to Investigate effects of Pulsed RF Therapy (PRFT) on  Arm Lymphedema Volume  Skin Blood Perfusion  Transcutaneous Oxygen

Subjects and Protocol • Seven post-mastectomy patients in pilot study • Unilateral Lymphedema All had prior CDT Tx • Each Pt. treated 4-6 times over 2-w eeks • During this interval no other Tx provided

Study Treatments • Each Tx for 60 minutes • Tx heads (Magnatherm) covered affected arm Dual Tx Dual Tx Heads Heads • Pulsed RF (27.12 MHz) On: 150  sec Off: 1275  sec (700/sec) • Pow er: ~ 12% of max

Physiological Measurements • Skin blood perfusion (SBF) by laser-Doppler SBF on affected arm PO2 • Transcutaneous O 2 (PO2) on affected and contralateral arm PO2

Volumes and Calculations Affected (A) & Control (C) arms measured before Tx and prior to each subsequent Tx • Circumferences (c 1 , c 2 ) at 4-cm intervals • Segmental volumes Vseg=(L/12  )(C 1 2 +C 2 2 +C 1 C 2 ) • Total arm volume V T = sum of segments • Edema volume V TA - V TC • Percent Edema %Edema= Edema Volume / V TC

Results

Edema Volume 0 .9 N=7 N=7  Decreased 0 .8 Edema Volume (L)  Further After one Tx 0 .7 Reduction 0 .6 Through 0 .5 4 th Tx * 0 .4 * * * 0 .3 0 .2 0 .1 0.64 0.50 0.42 0.41 0.35 0 .0 0 1 2 3 4 Tre at me nt s * p< 0.0 1 vs. initial ede ma volume

Percent Edema 35  After 4 Tx N=7 N=7 Percent Edema (%) 30 % edema w as ~ 1/2 of 25 pre-Tx level 20 * 15 * * * 10 5 24.5 18.5 15.8 15.3 12 .5 0 0 1 2 3 4 Trea tme nts * p< 0 .0 1 vs. initial %edema

Example SBF Response 4.5 SBF (a.u.) SBF Increased  Mean  Pulsatile 0.5 BASE ACTIVE OFF 10” 60” 20”

Overall SBF Response 9 0 0 N=7 * * Each 4 Tx * 7 0 0 SBF (a.u.) * 5 0 0 * ~30 minutes 3 0 0 Treatment 1 0 0 0 10 20 30 40 50 60 70 Time (minutes)

PO 2 Response 9 5 N=7 Initial Tx  9 0 A ffe c t e d No initial difference TcPO 2 (mmHg)  C o n t ro l No change w ith Tx 8 5 8 0 7 5 7 0 6 5 6 0 5 5 0 1 0 2 0 3 0 4 0 5 0 6 0 Treatment Time (minutes)

Conclusions: Volume Changes • PRFT show s potential benefit • Lymphedema reduced w ith one treatment • Initial PILOT findings are encouraging, BUT need placebo controlled studies (Ongoing)

Conclusions: Blood Perfusion • PRFT associated w ith SBF increase No effect on PO 2 (Normal levels) • Relation of SBF increase to lymphedema reduction (if any) not established • SPECULATION Mechanisms similar to those that increased SBF also increase lymph drainage  Expanding collateral channels  Increasing lymphoangiomotoricity

Magnatherm Affected PRFT Before Tx for 3 w ks PRFT 3 Sham + 6 Active Affected After PRFT TT 0-300

LDI PERFUSION CHANGES WITH PRFT Baseline 0-4 5-9 Magnatherm P=12, R=3, 30” 10-14 20-24 25-29 0-700 pu

DIFFERENTIAL LDI PERFUSION WITH PRFT 0-4 5-9 10-14 15-19 20-24 25-29