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

Effect of Pulsed RF Energy

• n 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

Art Pilla Marco Markov

• 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

Lymphedema

Treatment

Complex Decongestive Therapy (CDT)

• Manual Lymph Drainage
• Compression Bandaging
• Exercise and Skin Care

Current Study Rationale

• Pulsed RF (PRFT)

 Increases skin blood flow (SBF) via  Vascular channel enlargement HYPOTHESIS PRFT affects lymph channels similarly to blood channels

• CDT promotes lymph drainage

 Expands collateral channels  Provides alternative pathw ays

Superficial

Normal Pathw ays

Deep

S to D

“Substitutution” Pathw ays

Takeover requires a “kick-start”

 

Pulsed Pulsed RF RF

Objectives

Pilot study to Investigate effects of Pulsed RF Therapy (PRFT) on

 Arm Lymphedema Volume  Skin Blood Perfusion  Transcutaneous Oxygen

• 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

Subjects and Protocol

Study Treatments

• Each Tx for 60 minutes
• Tx heads (Magnatherm)

covered affected arm

• Pulsed RF (27.12 MHz)

On: 150 sec Off: 1275 sec (700/sec)

• Pow er: ~ 12% of max

Dual Tx Dual Tx Heads Heads

• Skin blood perfusion

(SBF) by laser-Doppler

• n affected arm
• Transcutaneous O2

(PO2) on affected and contralateral arm

SBF PO2 PO2

Physiological Measurements

Volumes and Calculations

• Circumferences (c 1

, c 2 ) at 4-cm intervals

• Segmental volumes

Vseg=(L/12)(C1

2+C2 2+C1

C2 )

• Total arm volume

V T = sum of segments

• Edema volume V TA - V TC
• Percent Edema

%Edema= Edema Volume / V TC

Affected (A) & Control (C) arms measured before Tx and prior to each subsequent Tx

Results

0 .0 0 .1 0 .2 0 .3 0 .4 0 .5 0 .6 0 .7 0 .8 0 .9

0.64 0.50 0.42 0.41 0.35

0 1 2 3 4

Tre at me nt s

* p< 0.0 1 vs. initial ede ma volume

* * * *

N=7 N=7 Edema Volume (L) Further Reduction Through 4 th Tx

Edema Volume

Decreased After one Tx

5 10 15 20 25 30 35

0 1 2 3 4

Trea tme nts

* p< 0 .0 1 vs. initial %edema

24.5 18.5 15.8 15.3 12 .5

* * * *

After 4 Tx % edema w as ~ 1/2 of pre-Tx level

Percent Edema

Percent Edema (%) N=7 N=7

Example SBF Response

SBF

(a.u.)

BASE ACTIVE OFF 10” 60” 20”

0.5 4.5

SBF Increased Mean Pulsatile

1 0 0 3 0 0 5 0 0 7 0 0 9 0 0

Time (minutes)

0 10 20 30 40 50 60 70

SBF (a.u.)

Treatment

N=7 Each 4 Tx

Overall SBF Response

* * * * * ~30 minutes

1 0 2 0 3 0 4 0 5 0 6 0 5 5 6 0 6 5 7 0 7 5 8 0 8 5 9 0 9 5 A ffe c t e d C o n t ro l

PO2 Response

TcPO2 (mmHg) Treatment Time (minutes)

N=7 Initial Tx

 No initial difference  No change w ith Tx

• PRFT show s potential benefit
• Lymphedema reduced w ith one treatment
• Initial PILOT findings are encouraging, BUT

need placebo controlled studies (Ongoing)

Conclusions: Volume Changes

Conclusions: Blood Perfusion

• PRFT associated w ith SBF increase

No effect on PO2 (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

Before PRFT After PRFT

TT 0-300

Affected

3 Sham + 6 Active

Magnatherm PRFT Tx for 3 w ks

Affected

Baseline 0-4 5-9 10-14 20-24 25-29

LDI PERFUSION CHANGES WITH PRFT

Magnatherm P=12, R=3, 30” 0-700 pu

DIFFERENTIAL LDI PERFUSION WITH PRFT

0-4 5-9 10-14 15-19 20-24 25-29