■淋巴水肿影响六分之一的乳腺癌幸存者,使其成为全球医疗保健挑战。关于淋巴水肿的不同治疗方法的疗效存在相当大的争论。我们旨在总结目前治疗乳腺癌幸存者淋巴水肿的证据。
■在这篇带有荟萃分析(SRMA)的系统综述中,在五个数据库中搜索了报告药物影响的随机对照试验(RCT)的SRMA,手术,锻炼,激光治疗,针灸,kinesio录音,或针对乳腺癌相关淋巴水肿的复杂减充血理疗(CDP),从数据库开始到2023年3月7日发表。对SRMA和RCT进行了数据提取,和SRMA用AMSTAR2进行了评估。RCT的随机效应荟萃分析提供了每种治疗方式的合并效应大小(Hedges\'g)的估计。这项研究在PROSPERO注册,CRD42020184813。
■通过搜索确定了1569项研究,其中包括18项SRMA和51项RCT,调查手动淋巴引流(MLD),压缩泵,锻炼,kinesio录音,激光,和针灸。总的来说,SRMA的方法学质量较低。SRMA对所有治疗方式得出了不同的结论,除了两个SRMA没有效果的kinesio录音。对1970名参与者进行的40项随机对照分析显示,与任何对照组相比,所有干预措施的效果较小(g=0.20,p=0.047,I2=0.79)。对应于干预组和对照组的体积减少119.7ml(95%CI135-104)和88.0ml(95%CI99-77),分别,运动效果小(g=0.26,p=0.022,I2=0.44)。对于任何一种治疗方式,组间体积减少的差异很小,均未达到统计学意义。
■根据现有数据,没有证据表明任何一种治疗方法在体积减小方面具有优越性,也没有任何可靠的研究反驳这些治疗方法.因此,无法得出明确的结论来告知临床实践这些治疗方法的疗效.由于证据质量差,需要更多的研究来理清每个治疗组件对不同阶段淋巴水肿的疗效。
■丹麦癌症协会。
UNASSIGNED: Lymphedema affects one in six breast cancer survivors making it a global healthcare challenge. There is considerable debate about the efficacy of different treatments for lymphedema. We aimed to summarize the current evidence for treatments for lymphedema in breast cancer survivors.
UNASSIGNED: In this overview of systematic reviews with meta-analyses (SRMAs), five databases were searched for SRMAs of randomised controlled trials (RCTs) reporting effects of medications, surgery, exercise, laser therapy, acupuncture, kinesio taping, or complex decongestive physiotherapy (CDP) for breast cancer-related lymphedema published from database inception up to March 7, 2023. Data extraction was performed for the SRMAs and RCTs, and SRMAs were appraised with AMSTAR2. Random effects meta-analyses of the RCTs provided estimates of the pooled effects sizes (Hedges\' g) for each treatment modality. This study is registered with PROSPERO, CRD42020184813.
UNASSIGNED: 1569 studies were identified by the search and eighteen SRMAs with 51 RCTs were included, investigating manual lymphatic drainage (MLD), compression pump, exercise, kinesio taping, laser, and acupuncture. Overall, the methodological quality of the SRMAs was low. SRMAs reached different conclusions for all treatment modalities, except for kinesio taping where the two SRMAs found no effect. The analysis of 40 RCTs with 1970 participants revealed a small effect across all interventions compared to any control (g = 0.20, p = 0.047, I2 = 0.79), corresponding to volume reductions of 119.7 ml (95% CI 135-104) and 88.0 ml (95% CI 99-77) in the intervention and control groups, respectively, and a small effect of exercise (g = 0.26, p = 0.022, I2 = 0.44). The between-group differences in volume reduction were small and did not reach statistical significance for any one treatment modality.
UNASSIGNED: Based on the available data, there is no evidence of superiority of any one treatment on volume reduction nor any solid research refuting these treatments. Thus, definitive conclusions to inform clinical practice about the efficacy of these treatments cannot be drawn. Due to poor-quality evidence, more research is needed to untangle the efficacy of each treatment component for different stages of lymphedema.
UNASSIGNED: Danish Cancer Society.