. 2024 Oct 17;41(11):288. doi: 10.1007/s12032-024-02447-w

Table 2.

RCTs of interventions across the treatment phases of lymphedema

Study/Country/ Cancer Type	Population/LE definition	Preventative intervention	Comparison intervention	Timelines & measurement method	Reported results
Secondary Prevention: upper limb (prior to onset of lymphedema)
Nadal Castells, [20] Spain Upper limb	N = 70 with BCRL undergoing ALND LE incidence: > 200mls or > 10% difference between limbs	n = 35 Age: 58.9 (12.7) 1-h education session + 12-week exercise session + CG (8-h per day for 3 months; 2-h per day after)	n = 35 Age: 56.1 (12.7) 1-h education session + 12-week exercise program	End of 12-week exercise program, 6 months, 1 year and 2 years Limb volume calculated from circumference measurements	2-year follow-up: no significant difference in incidence between groups (12.5% CG group vs. 12.1% comparison group)
Ochalek, [21] Poland Upper limb	N = 41 with BCRL undergoing ALND LE incidence: > 10% difference from pre-operative values	n = 20 Age: 52.9 (9.3) Exercise + circular-knit class I (15–21 mmHg) CG – replaced every 6 months	n = 21 Age: 64.0 (8.6) Exercise alone	1 year and 2 years Limb volume calculated from circumference measurements	1-year follow-up: no significant difference between groups (3 of 20 in CG group compared to 6 in the comparison group)
Paskett, [23] United States Upper limb	N = 554 females with BCRL LE incidence: ≥ 10% increase in affected limb volume	n = 312 Age: 58 (27–88) Education + exercise prescription CG (20–30 mmHg) to wear during exercise, air travel or vigorous activities	n = 242 Age: 59 (24–83) Education alone	Pre-operatively, 6-months, 1 year, and 18 months Limb volume calculated from circumference measurements	18-month follow-up: no significant difference between group: (140 of 312 in CG group vs 101 of 242 in comparison group)
Paramanandam, [22] India Upper limb	N = 301 females with BCRL LE incidence: ≥ 10% difference between limbs/ ≥ 10% change from baseline	n = 152 Age: 46.7 (10.4) Education + CG (20–25 mmHg) – worn post-op day 1 to 3 months post adjuvant cancer treatments: 8 h per day	n = 149 Age: 47.0 (11.7) Education alone	Pre-operatively, 2–4 weeks post-surgery, 5–7 months and at 1 year Limb volume calculated from circumference measurements	1-year follow-up: significantly reduced incidence in favor of CG group (22 of 152 in CG group compared vs 37 of 149 in comparison group)
Tertiary prevention: upper limb (at time of early presentation of lymphedema)
Blom, [17] Sweden Upper limb	N = 75 females with mild BCRL ≥ 2% increase LE incidence: ≥ 10% difference between limbs	n = 33 Age: 57.9 (13.8) Self-care: counseling exercise, weight control, skin care and self-massage + CG (Class 1 or adjusted Class 2)	n = 37 Age: 57.0 (12.5) Self-care alone	Post-operatively at 1 month, 2, 3 and 6 months Limb volume: water displacement	6-month follow-up: no significant difference between groups (4 of 33 in CG group vs 10 of 37 in comparison group)
Bundred, [18] United Kingdom Upper limb	N = 143 females with BCRL LE incidence: arm volume increase > 10% from baseline	n = 69 Age: 55.8 (32, 86.9) Education, elevation, exercise, and self-massage + CG (20–24 mmHG)	n = 74 Age: 55.5 (33.5, 89.9) Education, elevation, exercise, and self-massage	Pre-operatively, then at 1, 3, 6. 9, 12, 18 and 24 months Limb volume: perometry	2-year follow-up: no significant difference between groups (18 of 61in CG group vs 25 of 61 in comparison group)
Secondary prevention: lower limb
Hnin, [19] Singapore Lower limb	N = 56 females with gynecologic cancer Unilateral or bilateral LE incidence: Percentage change of > 15% or physical exam	n = 26 Age: 49.6 (24–66) Education + Custom CG (14–21 mmHg) worn: minimum 6 weeks, h worn reported	n = 30 Age: 47.8 (27–66) Education alone	Every 3 months in first year, every 4 months in second year Limb volume: perometry	2-year follow-up: no significant difference between groups (2 of 26 in CG vs 4 of 30 in comparison group)
Wang, [25] China Lower limb	N = 117 females with cervical cancer at high risk of LE LE incidence: clinical examination, symptoms + > 2% excess	n = 59 Age: 46.6 (9.3) Health education + modified CDT: self-MLD, aerobic exercise, + CG (15–30 mmHg)	n = 58 Age: 48.4 (9.8) Health education alone	Within 7–10 days after surgery, then 1, 3, 6 and 12 months Limb volume calculated from circumference measurements	Significant benefit in favor of CG (8 of 58 in modified CDT group vs 20 of 59 in comparison group)
Shallwani, [24] Canada Lower limb	N = 36 females with gynecologic cancer LE incidence: clinical examination	n = 18 Age: 56.3 (10.1) Education and aerobic and resistance exercise prescription + standard or custom CG (18–21 mmHg) to be worn 12–16 h/day for 6 months	n = 18 Age: 58.9 (9.1) Education and standard care (CG provided if LE developed)	Pre-operatively, 4–6 weeks post-op, then at 3, 6 and 12-months Limb volume calculated from circumference measurements and perometry	No significant difference. 1-year follow-up (5 of 18 in CG group vs 5 of 18 in comparison group)
Alternative intervention to compression bandaging
Oh, [31] Korea Upper limb	N = 42 patients with BCRL	N = 21 Age: 57.3 ± 5.6 yrs CDT using spiral method for CB; 2-week intervention	N = 21 Age: 56.4 ± 7.9 yrs CDT using spica/figure-of-eight method for CB; 2-week intervention	Baseline, post-treatment (2 weeks) Limb volume: water volumetry: distal and proximal segments	The spica method/significantly better volume reduction than the spiral method
Pujol-Blaya, [34] Spain Upper limb	N = 42 patients with BCRL	N = 22 Age: 58.6 ± 12.1 yrs MLD + precast adjustable compression system; daily × 2 weeks; then 3 days (alternate days) per week × 7–14 days until garment received	N = 20 Age: 60.4 ± 12.1 yrs MLD + CB; daily × 2 weeks; then 3 days (alternate days) per week × 7–14 days until garment received	Baseline, post-treatment (2 weeks) and 3-months follow-up Limb volume: water volumetry Circumference measurements for distal and proximal segments	No significant difference between groups
Dhar, [28] India Upper limb	N = 49 female patients with BCRL	N = 25 Age: 50.8 ± 10.2 yrs Mobiderm reapplied 3 × during week 1 and 1 × during week 2	N = 24 Age: 54.9 ± 11.1 yrs CB reapplied 3 × during week 1 and 1 × during week 2	Baseline, post-treatment (15 days) Limb volume: water volumetry	Significant benefit in favour of Mobiderm over traditional CB
Alternative intervention: extracorporeal shock wave therapy (ESWT)
Cebicci, [27] Turkey Upper limb	N = 20 female patients with BCRL	N = 10 Age: 51.6 ± 6.6 yrs ESWT; 3 sessions/week × 12 sessions	N = 10 Age: 57.9 ± 6.9 yrs CDT; 5x/week for 20 sessions	Baseline, post-treatment (4 weeks) Limb volume: water displacement Circumference measurements	No between group differences
Alternative intervention: compression pump (CP)
Haghighat, [29] Iran Upper limb	N = 112 unilateral BCRL LE: ≥ 10% difference in limbs	n = 56 Age: 52.7 (10.8) years Modified CDT (limited MLD) + CP for 30 min @ 40 mmHg pressure: daily for 5 days per week for 2–3 weeks Maintenance: CG, night CB, exercise, and self-massage	n = 56 Age: 53.4 (11.4) years CDT: daily 5 days per week for 2–3 weeks Maintenance: CG, night CB, exercise, and self-massage	Baseline, post-treatment (2–3 weeks), 3-month follow-up Limb volume: water displacement	Significant benefit in favor comparison intervention post-intervention No significant difference between groups at 3-month follow-up
Sanal-Toprak, [35] Turkey Upper limb	N = 46 patients with advanced-stage BCRL	N = 22 Age: 55.3 ± 10.3 yrs Pneumatic compression & CB; 3 days/week × 5 weeks	N = 24 Age: 59.0 ± 2.8 yrs MLD and CB; 3 days/week × 5 weeks	Baseline, post-treatment (5 weeks), and 3-month follow-up Circumference measurements	No reported limb volume data There were no significant between group differences
Alternative intervention: elastic taping (ET)
Smylka, [37] Poland Upper limb	N = 43 females with BCRL LE: Stage II or III with > 20% difference	n = 20 Age: 67.3 (12.0) years IPC, MLD and ET: 3x/ week for 4 weeks n = 22 Age: 65.4 (13.1) years IPC, MLD and sham ET: 3x/ week for 4 weeks	n = 23 Age: 66.5 (12.0) years IPC, MLD, CB: 3 × per week for 4 weeks	Baseline, post-intervention (4 weeks) Limb volume: perometry	Analysis of ET and CB intervention groups only No significant differences between groups post-intervention
Pekyavas, included in alternative and adjunctive categories [33] Turkey Upper limb	N = 30 BCRL LE: Stage II or III LE	n = 15 Age: 58.0 (8.5) years CDT: daily, 10-day treatment with ET replacing the CB Maintenance: self-massage, exercise, and CG	n = 15 Age: 49.6 (10.5) years CDT: daily, 10-day treatment period Maintenance: self-massage, exercise, and CG	Baseline, post-intervention (Day 10), and 1-month post-intervention follow-up Limb volume calculated from circumference measurements	Analysis of ET and CB intervention groups only No significant differences between groups post-intervention
Melgaard, [30] Denmark Upper limb	N = 10 females with Level 2 BCRL	N = 5 Age: 63.0 ± 9.8 yrs CDT with ET: 2 days/week × 4 weeks	N = 5 Age: 62.0 ± 5.8 yrs CDT with CB; daily × 5 days/week × 4 weeks	Baseline and post-treatment (4 weeks) Circumference measurements	No reported limb volume data Significant benefit in favor of the ET group post-intervention
Ozsoy-Unubol, [32] Turkey Upper Limb	N = 35 patients with early-stage BCRL	N = 16 Age: 50.6 ± 6.5 yrs ET: 3 4-day intervals × 4 weeks	N = 19 Age: 54.5 ± 7.5 yrs Compression garment: 23 h/day × 4 weeks	Baseline, post-treatment (4 weeks), and 3-month follow-up Circumference measurements	No reported limb volume data
Tantawy, [38] Egypt Upper limb	N = 59 female patients with BCRL	N = 30 Age: 54.3 ± 4.2 yrs ET: 2x/week × 3 weeks	N = 29 Age: 55.2 ± 3.3 yrs Compression garment: daily × 15–18 h × 3 weeks	Baseline and post-treatment (3 weeks) Circumference measurements	No reported limb volume data Analysis of post-intervention scores favor ET group*
Basoglu, [26] Turkey Upper limb	N = 36 female patients with Level 2 BCRL	N = 17 Age: 53.7 ± 8.6 yrs ET: 1x/week × 4 weeks	N = 19 Age: 53.4 ± 8.3 yrs CDT; 1x/week × 4 weeks	Baseline, post-treatment (4 weeks), and 1-month follow-up Limb volume calculated from circumference measurements	Significant benefit in favor of CDT group post-intervention
Alternative: multiple comparison interventions
Torres-Lacomba, [39] Spain Upper limb	N = 146 female patients with Stage I and II BCRL Age: 58.4 ± 11.4 yrs	N = 118 Intervention details: simplified CB, MLD, exercise, and pneumatic compression (group 1); cohesive CB, MLD, exercise, and pneumatic compression (group 2); adhesive CB, MLD, exercise, and pneumatic compression (group 3); ET, MLD, exercise, and pneumatic compression (group 4; daily × 5 days/week × 2 weeks for intensive phase; then alternate days × 1 week	N = 28 Intervention details: multilayer CB, MLD, exercise, and pneumatic compression; daily × 5 days/week × 2 weeks for intensive phase; then alternate days × 1 week	Baseline, post-intervention (3 weeks) Limb volume calculated from circumference measurements	Limb volume data presented as median and range Simplified CB more effective than traditional CB: Traditional CB more effective than Adhesive CB; No difference: Cohesive; Traditional CB more effective than ET
Selcuk Ylimaz, [36] Turkey Upper limb	N = 48 patients with mild Stage 2 BCRL	N = 33 Age: 51.4 ± 10.7 yrs (ET group); 55.3 ± 12.1 yrs (LLLT group) ET and CB (ET group) or LLLT and CB (LLLT group): 15 sessions over 3 weeks, followed by maintenance with CG	N = 15 Age: 57.6 ± 9.5 yrs MLD (Vodder massage × 30–45 min/ session) and CB (MLD group): 15 sessions over 3 weeks, followed by maintenance with CG	Baseline, post-intervention (3 weeks), then 4 and 12 weeks after end of treatment Limb volume calculated from circumference measurements	Significant difference in favor of the ET group compared to the MLD group post-treatment
Adjunctive intervention: extracorporeal shock wave therapy
El-Shazly, [40] Egypt Upper limb	N = 60 females BCRL (age range of 30 to 50 years) LE definition: unilateral; Stage II or III (advanced stage)	n = 30 Age: not reported MLD, exercises, shoulder ROM, IPC: 3x/ week for 6 weeks + ESWT: 2x/ week for 6 weeks 2022	n = 30 Age: not reported MLD, exercises, shoulder ROM, IPC: 3x/ week for 6 weeks	Baseline and post-intervention (6 weeks) Limb volume: method not reported	Significant benefit in favor of ESWT
Mahran, [41] Egypt Upper limb	N = 40 post-menopausal females with BCRL LE: 2 cm to 8 cm difference in circumference at any point or > 200 ml difference in limbs	n = 20 Age: 52.1 (4.0) years CDT 3x/week for 8 weeks + ESWT 2x/ week for 8 weeks	n = 20 Age: 53.8 (3.4) years CDT 3x/week for 8 weeks	Baseline, post-intervention (4 weeks) and 8 weeks Limb volume: water displacement	Significant difference in favor of the ESWT at 4 weeks and 8 weeks
Lee, [12] Korea Upper limb	N = 28 females with BCRL LE: Stage II; > 2 cm between arms at points on arm, and a volume difference of 200 + mls	n = 14 Age: 57.5 (11.2) years CDT daily for 3 weeks + ESWT 3x/ week for 3 weeks	n = 14 Age: 53.2 (8.6) years CDT daily for 3 weeks	Baseline, post-treatment (3 weeks), and 3 months Limb volume: water displacement	No significant differences between the groups at the 3-week or 3-month follow-up
Adjunctive intervention: compression pump
Szuba, [44] United States Upper limb	N = 23 females with BCRL LE: ≥ 20% difference in limbs	n = 12 Age: 68.8 (9.1) years CDT + IPC × 30 min @ 40–50 mmHg pressure: daily for 2 weeks	n = 11 Age: 65.0 (10.8) years CDT: daily for 2 weeks	Baseline, post-intervention (10 day), 1-month follow-up Limb volume: water displacement	Significant benefit in favor of IPC post-intervention*
Szolnoky, [43] Hungary Upper limb	N = 27 females with unilateral BCRL LE: definition not reported	n = 14 Age: mean 56.6 years CDT with MLD × 30 min + IPC × 30 min: daily 5 days per week for 2 weeks	n = 13 Age: mean 54.8 years CDT (MLD: 60 min): daily 5 days/ week for 2 weeks	Baseline, start of intervention, post-intervention, 1 and 2-month follow-ups Limb volume calculated from circumference measurements	Significant benefit in favor of IPC at all time points*
Adjunctive intervention: low level laser therapy (LLLT)
Mogahed, [42] Egypt Upper limb	N = 30 females with BCRL LE: Stage II and III	n = 15 Age: 48.4 (4.1) years MLD, exercise, IPC: 3x/ week for 12 weeks + LLLT: infrared, pulsed; axillary region; 2 Joules/cm²	n = 15 Age: 48.3 (4.1) years MLD, exercise, IPC + Placebo LLLT	Baseline, post-intervention Limb volume: water volumetry	Significant difference in favor of LLLT
Adjunctive intervention: elastic taping (ET)
Pekyavas,—included in alternative and adjunctive categories [33] Turkey Upper limb	N = 30 BCRL LE: Stage II or III LE	n = 15 Age: 58.0 (8.5) years CDT: daily, 10-day treatment with ET applied under CB Maintenance: self-massage, exercise, and CG	n = 15 Age: 49.6 (10.5) years CDT: daily, 10-day treatment period Maintenance: self-massage, exercise, and CG	Baseline, post-intervention (Day 10), and 1-month post-intervention follow-up Limb volume calculated from circumference measurements	Analysis of two of three intervention groups No significant differences between groups post-intervention
Collins, [46] Ireland Breast edema	N = 14 females with BCRL LE: a ratio of ≥ 1.1:1 tissue water difference	n = 7 Age: 64.1 (5.9) years MLD × 20 min, 1x/ week for 3 weeks + ET for two 7-day periods	n = 7 Age: 53.9 (10.4) years MLD × 20 min, 1x/ week for 3 weeks	Baseline, post-intervention (2 weeks), and 6-week post-intervention follow-up Breast percentage tissue water	Measures of variability not reported No between group analyses reported
Atar, [45] Turkey Head & Neck	N = 58 with HNL Males: 35; Females: 23 LE: edema ≥ 3 months; excluded MDACC HNL scale levels 0 and 3	n = 30 Age: 51.5 (7.7) years Daily MLD × 1 week, then MLD 2 × per week for 3 weeks; daily exercise × 4 weeks; ET applied daily × 1 week, then 3x/ week for 3 weeks. Maintenance: daily home exercises week 5–8	n = 28 Age: 51.1 (8.8) years Daily MLD × 1 week, then MLD 2 × per week for 3 weeks; daily exercise × 4 weeks; sham ET applied daily × 1 week, then 3x/ week for 3 weeks. Maintenance: daily home exercises week 5–8	Baseline, post-intervention and 8-week follow-up Tape measurements for external LE; Fiber endoscopic images for internal LE analyzed into categories	Data analyzed for total circumference A significant benefit found in favor of ET group for external LE
Stand-alone intervention: low level laser therapy (LLLT)
Carati, [48] Australia Upper limb	N = 61 females with BCRL LE: > 200 ml difference or ≥ 2 cm difference circumference at 3 points	n = 33 Age: 65 (2) years LLLT: 9 sessions (3x/ week for 3 weeks) with 17 treatment points (17 min) @ dosage of 1.5 Joules/cm²	n = 28 Age: 63 (2) years Sham LLLT: 9 sessions (3x/ week for 3 weeks) with 17 treatment points—no laser delivered	Baseline, post-intervention (3 weeks), 1-month, and 2–3-month post-intervention follow-up Limb volume: perometry	No data to allow for analysis prior to cross-over Significant benefit in favor of LLLT at follow-up
Lau, [50] China Upper limb	N = 21 females with BCRL LE: > 200 mL difference	n = 11 Age: 50.9 (8.6) years LLLT: 12 sessions—3x/ week for 20 min for 4 weeks; 50 cm laser head for 144cm² area; @ dosage 2 Joules/cm²	n = 10 Age: 51.3 (8.9) years Control: no intervention	Baseline, post-intervention (4 weeks), 4-weeks post-intervention follow-up Limb volume: water volumetry	No significant difference between the groups post-intervention; Significant benefit in favor of laser therapy at follow-up
Storz, [54] Germany Upper limb	N = 36 females with BCRL LE: 3-month history of LE	n = 17 Age: 61.1 (9.7) years LLLT: 8 sessions—2x/ week for 4 weeks for 10 min; 4.9 cm² treatment head; 78.54 cm² treatment area @ dosage of 4.89 Joules/cm²	n = 19 Age: 59.4 (10.2) years Placebo LLLT	Baseline, post-intervention (4 weeks), 4, 8, 12 weeks post-intervention follow-up Limb volume calculated from circumference measurements	No data on mean or standard deviation No significant differences between the groups post-intervention or at any follow-up
Stand-alone intervention: elastic taping (ET)
Malicka, [51] Poland Upper limb	N = 28 females with early-stage BCRL LE: Grade 1 lymphedema	N = 14 60.1 (6.3) Intervention details: ET (two subgroups: 1) upper extremity with single fan shapes; 2) upper extremity in a double fan shape with arm and forearm); applied 1x/week × 4 weeks	N = 14 59.5 (5.7) Intervention details: no treatment	Baseline, 2 weeks, and post-intervention (4 weeks) Limb volume calculated from circumference measurements	Within-group difference for ET group; between-group differences not presented
Stand-alone mixed interventions
Abdelhalim, [47] Egypt Upper limb	N = 43 females with BCRL LE: difference of 2 to 8 cm at a single measurement site between arms	n = 21 Age: 48.7 (3.1) ESWT 2500 shocks per session @ frequency of 4 Hz and flow density of 90 mJ; 3x/ week for 4 weeks (12 sessions) Daily home program: range of motion, pumping exercises and elevation	n = 22 Age: 49.6 (2.8) IPC (60 mmHg) for 45 min, 5 times/week for 4 weeks (20 sessions) Daily home program: range of motion, pumping exercises and elevation	Baseline and post-intervention (4 weeks) Circumference measurements	No data on limb volume Significant difference between groups at 4 measurement levels favouring ESWT group
Maintenance: night-time compression
Mestre, [53] France Upper Limb	N = 40 females with BCRL post intensive CDT LE: eligible if a > 10% reduction in Phase I CDT	n = 20; Age: 65.1 (8.6) Daytime CG (Class I or II) + Night-time Compression system	n = 20; Age: 68.9 (11.8) Daytime CG (Class I or II)	Baseline, then Day 30 and Day 90 (fast-track Day 30 to 90) Limb volume calculated from circumference measurements	At Day 30 post-intervention: no significant differences between groups
McNeely, [52] Canada Upper limb	N = 120 females with BCRL LE: ≥ 200 ml or ≥ 10% difference between limbs	n = 44; Age: 62 (9) Education, Daytime CG (Class II) + Night-time CB Group: 8 h/ night for 5 nights x 6wks, then 3 nights × 6 wks n = 37; Age: 62 (12) Education, Daytime CG (Class II) + Night-time Compression System Group: 8 h for 5 nights/wk for 6wks, then 8 h × 3 nights/wk for 6 wks	n = 39; Age: 59 (11) Standard care: Education + Day-time CG (Class II)	Baseline and then 6, 12, 18, 24 weeks (fast-track from 12–24 weeks) Limb volume: perometry	At 12-weeks post-intervention: significant benefit in favour of NCSG and CB groups vs comparison group
Maintenance: compression pump
Fife, [49] United States Upper Limb	N = 36 LE: eligible if ≥ 5% excess volume	n = 18; Age: 63.9 (12.2) Advanced pneumatic compression device including arm, adjacent chest, and truncal quadrant: home treatment 60 min/ day for 12-weeks @ a pressure between 9 and 13 mmHg	n = 18; Age: 59.7 (12.6) Standard pneumatic compression device with 4 chambers for arm: home treatment 60 min /day for 12-weeks @ pressure of 30 mmHg	Baseline, and then 12-weeks post-intervention Limb volume calculated from circumference measurements	At 12-weeks post-intervention: significant benefit in favor of Advanced Pneumatic Compression
Rockson, [55] United States Upper Limb	N = 50 females with BCRL LE: diagnosis of upper limb lymphedema	n = 23; Age: 60.5 (10.8) CG + Non-pneumatic wearable compression system for a minimum of 60 min/ day for 28 days	n = 27; Age: 60.3 (10.8) CG + Advanced pneumatic compression for a minimum of 60 min/ day for 28 days	Baseline, then Day 28 post-intervention Limb volume calculated from circumference measurements	At Day 28: analyses based on published data suggest borderline significance

Study/Country/
Cancer Type

Population/LE definition

Preventative intervention

Comparison intervention

Timelines & measurement method

Reported results

Secondary Prevention: upper limb (prior to onset of lymphedema)

Nadal Castells, [20]

Spain

Upper limb

N = 70 with BCRL undergoing ALND

LE incidence: > 200mls or > 10% difference between limbs

n = 35

Age: 58.9 (12.7)

1-h education session + 12-week exercise session + CG (8-h per day for 3 months; 2-h per day after)

n = 35

Age: 56.1 (12.7)

1-h education session + 12-week exercise program

End of 12-week exercise program, 6 months, 1 year and 2 years

Limb volume calculated from circumference measurements

2-year follow-up: no significant difference in incidence between groups (12.5% CG group vs. 12.1% comparison group)

Ochalek, [21]

Poland

Upper limb

N = 41 with BCRL undergoing ALND

LE incidence: > 10% difference from pre-operative values

n = 20

Age: 52.9 (9.3)

Exercise + circular-knit class I (15–21 mmHg) CG – replaced every 6 months

n = 21

Age: 64.0 (8.6)

Exercise alone

1 year and 2 years

Limb volume calculated from circumference measurements

1-year follow-up: no significant difference between groups (3 of 20 in CG group compared to 6 in the comparison group)

Paskett, [23]

United States

Upper limb

N = 554 females with BCRL

LE incidence: ≥ 10% increase in affected limb volume

n = 312

Age: 58 (27–88)

Education + exercise prescription CG (20–30 mmHg) to wear during exercise, air travel or vigorous activities

n = 242

Age: 59 (24–83)

Education alone

Pre-operatively, 6-months, 1 year, and 18 months

Limb volume calculated from circumference measurements

18-month follow-up: no significant difference between group: (140 of 312 in CG group vs 101 of 242 in comparison group)

Paramanandam, [22]

India

Upper limb

N = 301 females with BCRL

LE incidence: ≥ 10% difference between limbs/ ≥ 10% change from baseline

n = 152

Age: 46.7 (10.4)

Education + CG (20–25 mmHg) – worn post-op day 1 to 3 months post adjuvant cancer treatments: 8 h per day

n = 149

Age: 47.0 (11.7)

Education alone

Pre-operatively, 2–4 weeks post-surgery, 5–7 months and at 1 year

Limb volume calculated from circumference measurements

1-year follow-up: significantly reduced incidence in favor of CG group (22 of 152 in CG group compared vs 37 of 149 in comparison group)

Tertiary prevention: upper limb (at time of early presentation of lymphedema)

Blom, [17]

Sweden

Upper limb

N = 75 females with mild BCRL ≥ 2% increase

LE incidence: ≥ 10% difference between limbs

n = 33

Age: 57.9 (13.8)

Self-care: counseling exercise, weight control, skin care and self-massage + CG (Class 1 or adjusted Class 2)

n = 37

Age: 57.0 (12.5)

Self-care alone

Post-operatively at 1 month, 2, 3 and 6 months

Limb volume: water displacement

6-month follow-up: no significant difference between groups (4 of 33 in CG group vs 10 of 37 in comparison group)

Bundred, [18]

United Kingdom

Upper limb

N = 143 females with BCRL

LE incidence: arm volume increase > 10% from baseline

n = 69

Age: 55.8 (32, 86.9)

Education, elevation, exercise, and self-massage + CG (20–24 mmHG)

n = 74

Age: 55.5 (33.5, 89.9)

Education, elevation, exercise, and self-massage

Pre-operatively, then at 1, 3, 6. 9, 12, 18 and 24 months

Limb volume: perometry

2-year follow-up: no significant difference between groups (18 of 61in CG group vs 25 of 61 in comparison group)

Secondary prevention: lower limb

Hnin, [19]

Singapore

Lower limb

N = 56 females with gynecologic cancer

Unilateral or bilateral LE incidence: Percentage change of > 15% or physical exam

n = 26

Age: 49.6 (24–66)

Education + Custom CG (14–21 mmHg) worn: minimum 6 weeks, h worn reported

n = 30

Age: 47.8 (27–66)

Education alone

Every 3 months in first year, every 4 months in second year

Limb volume: perometry

2-year follow-up: no significant difference between groups (2 of 26 in CG vs 4 of 30 in comparison group)

Wang, [25]

China

Lower limb

N = 117 females with cervical cancer at high risk of LE

LE incidence: clinical examination, symptoms + > 2% excess

n = 59

Age: 46.6 (9.3)

Health education + modified CDT: self-MLD, aerobic exercise, + CG (15–30 mmHg)

n = 58

Age: 48.4 (9.8)

Health education alone

Within 7–10 days after surgery, then 1, 3, 6 and 12 months

Limb volume calculated from circumference measurements

Significant benefit in favor of CG (8 of 58 in modified CDT group vs 20 of 59 in comparison group)

Shallwani, [24]

Canada

Lower limb

N = 36 females with gynecologic cancer

LE incidence: clinical examination

n = 18

Age: 56.3 (10.1)

Education and aerobic and resistance exercise prescription + standard or custom CG (18–21 mmHg) to be worn 12–16 h/day for 6 months

n = 18

Age: 58.9 (9.1)

Education and standard care (CG provided if LE developed)

Pre-operatively, 4–6 weeks post-op, then at 3, 6 and 12-months

Limb volume calculated from circumference measurements and perometry

No significant difference. 1-year follow-up (5 of 18 in CG group vs 5 of 18 in comparison group)

Alternative intervention to compression bandaging

Oh, [31]

Korea

Upper limb

N = 42 patients with BCRL

N = 21

Age: 57.3 ± 5.6 yrs

CDT using spiral method for CB; 2-week intervention

N = 21

Age: 56.4 ± 7.9 yrs

CDT using spica/figure-of-eight method for CB; 2-week intervention

Baseline, post-treatment (2 weeks)

Limb volume: water volumetry: distal and proximal segments

The spica method/significantly better volume reduction than the spiral method

Pujol-Blaya, [34]

Spain

Upper limb

N = 42 patients with BCRL

N = 22

Age: 58.6 ± 12.1 yrs

MLD + precast adjustable compression system; daily × 2 weeks; then 3 days (alternate days) per week × 7–14 days until garment received

N = 20

Age: 60.4 ± 12.1 yrs

MLD + CB; daily × 2 weeks; then 3 days (alternate days) per week × 7–14 days until garment received

Baseline, post-treatment (2 weeks) and 3-months follow-up

Limb volume: water volumetry

Circumference measurements for distal and proximal segments

No significant difference between groups

Dhar, [28]

India

Upper limb

N = 49 female patients with BCRL

N = 25

Age: 50.8 ± 10.2 yrs

Mobiderm reapplied 3 × during week 1 and 1 × during week 2

N = 24

Age: 54.9 ± 11.1 yrs

CB reapplied 3 × during week 1 and 1 × during week 2

Baseline, post-treatment (15 days)

Limb volume: water volumetry

Significant benefit in favour of Mobiderm over traditional CB

Alternative intervention: extracorporeal shock wave therapy (ESWT)

Cebicci, [27]

Turkey

Upper limb

N = 20 female patients with BCRL

N = 10

Age: 51.6 ± 6.6 yrs

ESWT; 3 sessions/week × 12 sessions

N = 10

Age: 57.9 ± 6.9 yrs

CDT; 5x/week for 20 sessions

Baseline, post-treatment (4 weeks)

Limb volume: water displacement

Circumference measurements

No between group differences

Alternative intervention: compression pump (CP)

Haghighat, [29]

Iran

Upper limb

N = 112 unilateral BCRL

LE: ≥ 10% difference in limbs

n = 56

Age: 52.7 (10.8) years

Modified CDT (limited MLD) + CP for 30 min @ 40 mmHg pressure: daily for 5 days per week for 2–3 weeks

Maintenance: CG, night CB, exercise, and self-massage

n = 56

Age: 53.4 (11.4) years

CDT: daily 5 days per week for 2–3 weeks

Maintenance: CG, night CB, exercise, and self-massage

Baseline, post-treatment (2–3 weeks), 3-month follow-up

Limb volume: water displacement

Significant benefit in favor comparison intervention post-intervention

No significant difference between groups at 3-month follow-up

Sanal-Toprak, [35]

Turkey

Upper limb

N = 46 patients with advanced-stage BCRL

N = 22

Age: 55.3 ± 10.3 yrs

Pneumatic compression & CB; 3 days/week × 5 weeks

N = 24

Age: 59.0 ± 2.8 yrs

MLD and CB; 3 days/week × 5 weeks

Baseline, post-treatment (5 weeks), and 3-month follow-up

Circumference measurements

No reported limb volume data

There were no significant between group differences

Alternative intervention: elastic taping (ET)

Smylka, [37]

Poland

Upper limb

N = 43 females with BCRL

LE: Stage II or III with > 20% difference

n = 20

Age: 67.3 (12.0) years

IPC, MLD and ET: 3x/ week for 4 weeks

n = 22

Age: 65.4 (13.1) years

IPC, MLD and sham ET: 3x/ week for 4 weeks

n = 23

Age: 66.5 (12.0) years

IPC, MLD, CB: 3 × per week for 4 weeks

Baseline, post-intervention (4 weeks)

Limb volume: perometry

Analysis of ET and CB intervention groups only

No significant differences between groups post-intervention

Pekyavas, included in alternative and adjunctive categories [33]

Turkey

Upper limb

N = 30 BCRL

LE: Stage II or III LE

n = 15

Age: 58.0 (8.5) years

CDT: daily, 10-day treatment with ET replacing the CB

Maintenance: self-massage, exercise, and CG

n = 15

Age: 49.6 (10.5) years

CDT: daily, 10-day treatment period

Maintenance: self-massage, exercise, and CG

Baseline, post-intervention (Day 10), and 1-month post-intervention follow-up

Limb volume calculated from circumference measurements

Analysis of ET and CB intervention groups only

No significant differences between groups post-intervention

Melgaard, [30]

Denmark

Upper limb

N = 10 females with Level 2 BCRL

N = 5

Age: 63.0 ± 9.8 yrs

CDT with ET: 2 days/week × 4 weeks

N = 5

Age: 62.0 ± 5.8 yrs

CDT with CB; daily × 5 days/week × 4 weeks

Baseline and post-treatment (4 weeks)

Circumference measurements

No reported limb volume data

Significant benefit in favor of the ET group post-intervention

Ozsoy-Unubol, [32]

Turkey

Upper Limb

N = 35 patients with early-stage BCRL

N = 16

Age: 50.6 ± 6.5 yrs

ET: 3 4-day intervals × 4 weeks

N = 19

Age: 54.5 ± 7.5 yrs

Compression garment:

23 h/day × 4 weeks

Baseline, post-treatment (4 weeks), and 3-month follow-up

Circumference measurements

No reported limb volume data

Tantawy, [38]

Egypt

Upper limb

N = 59 female patients with BCRL

N = 30

Age: 54.3 ± 4.2 yrs

ET: 2x/week × 3 weeks

N = 29

Age: 55.2 ± 3.3 yrs

Compression garment: daily × 15–18 h × 3 weeks

Baseline and post-treatment (3 weeks)

Circumference measurements

No reported limb volume data

Analysis of post-intervention scores favor ET group*

Basoglu, [26]

Turkey

Upper limb

N = 36 female patients with Level 2 BCRL

N = 17

Age: 53.7 ± 8.6 yrs

ET: 1x/week × 4 weeks

N = 19

Age: 53.4 ± 8.3 yrs

CDT; 1x/week × 4 weeks

Baseline, post-treatment (4 weeks), and 1-month follow-up

Limb volume calculated from circumference measurements

Significant benefit in favor of CDT group post-intervention

Alternative: multiple comparison interventions

Torres-Lacomba, [39]

Spain

Upper limb

N = 146 female patients with Stage I and II BCRL

Age: 58.4 ± 11.4 yrs

N = 118

Intervention details:

simplified CB, MLD, exercise, and pneumatic compression (group 1); cohesive CB, MLD, exercise, and pneumatic compression (group 2); adhesive CB, MLD, exercise, and pneumatic compression (group 3); ET, MLD, exercise, and pneumatic compression (group 4; daily × 5 days/week × 2 weeks for intensive phase; then alternate days × 1 week

N = 28

Intervention details:

multilayer CB, MLD, exercise, and pneumatic compression; daily × 5 days/week × 2 weeks for intensive phase; then alternate days × 1 week

Baseline, post-intervention (3 weeks)

Limb volume calculated from circumference measurements

Limb volume data presented as median and range

Simplified CB more effective than traditional CB:

Traditional CB more effective than Adhesive CB;

No difference: Cohesive; Traditional CB more effective than ET

Selcuk Ylimaz, [36]

Turkey

Upper limb

N = 48 patients with mild Stage 2 BCRL

N = 33

Age: 51.4 ± 10.7 yrs (ET group); 55.3 ± 12.1 yrs (LLLT group)

ET and CB (ET group) or LLLT and CB (LLLT group): 15 sessions over 3 weeks, followed by maintenance with CG

N = 15

Age: 57.6 ± 9.5 yrs

MLD (Vodder massage × 30–45 min/ session) and CB (MLD group): 15 sessions over 3 weeks, followed by maintenance with CG

Baseline, post-intervention (3 weeks), then 4 and 12 weeks after end of treatment

Limb volume calculated from circumference measurements

Significant difference in favor of the ET group compared to the MLD group post-treatment

Adjunctive intervention: extracorporeal shock wave therapy

El-Shazly, [40]

Egypt

Upper limb

N = 60 females BCRL (age range of 30 to 50 years)

LE definition: unilateral; Stage II or III (advanced stage)

n = 30

Age: not reported

MLD, exercises, shoulder ROM, IPC: 3x/ week for 6 weeks + ESWT: 2x/ week for 6 weeks 2022

n = 30

Age: not reported

MLD, exercises, shoulder ROM, IPC: 3x/ week for 6 weeks

Baseline and post-intervention (6 weeks)

Limb volume: method not reported

Significant benefit in favor of ESWT

Mahran, [41]

Egypt

Upper limb

N = 40 post-menopausal females with BCRL

LE: 2 cm to 8 cm difference in circumference at any point or > 200 ml difference in limbs

n = 20

Age: 52.1 (4.0) years

CDT 3x/week for 8 weeks + ESWT 2x/ week for 8 weeks

n = 20

Age: 53.8 (3.4) years

CDT 3x/week for 8 weeks

Baseline, post-intervention (4 weeks) and 8 weeks

Limb volume: water displacement

Significant difference in favor of the ESWT at 4 weeks and 8 weeks

Lee, [12]

Korea

Upper limb

N = 28 females with BCRL

LE: Stage II; > 2 cm between arms at points on arm, and a volume difference of 200 + mls

n = 14

Age: 57.5 (11.2) years

CDT daily for 3 weeks + ESWT 3x/ week for 3 weeks

n = 14

Age: 53.2 (8.6) years

CDT daily for 3 weeks

Baseline, post-treatment (3 weeks), and 3 months

Limb volume: water displacement

No significant differences between the groups at the 3-week or 3-month follow-up

Adjunctive intervention: compression pump

Szuba, [44]

United States

Upper limb

N = 23 females with BCRL

LE: ≥ 20% difference in limbs

n = 12

Age: 68.8 (9.1) years

CDT + IPC × 30 min @ 40–50 mmHg pressure: daily for 2 weeks

n = 11

Age: 65.0 (10.8) years

CDT: daily for 2 weeks

Baseline, post-intervention (10 day), 1-month follow-up

Limb volume: water displacement

Significant benefit in favor of IPC post-intervention*

Szolnoky, [43]

Hungary

Upper limb

N = 27 females with unilateral BCRL

LE: definition not reported

n = 14

Age: mean 56.6 years

CDT with MLD × 30 min + IPC × 30 min: daily 5 days per week for 2 weeks

n = 13

Age: mean 54.8 years

CDT (MLD: 60 min): daily 5 days/ week for 2 weeks

Baseline, start of intervention, post-intervention, 1 and 2-month follow-ups

Limb volume calculated from circumference measurements

Significant benefit in favor of IPC at all time points*

Adjunctive intervention: low level laser therapy (LLLT)

Mogahed, [42]

Egypt

Upper limb

N = 30 females with BCRL

LE: Stage II and III

n = 15

Age: 48.4 (4.1) years

MLD, exercise, IPC: 3x/ week for 12 weeks + LLLT: infrared, pulsed; axillary region; 2 Joules/cm²

n = 15

Age: 48.3 (4.1) years

MLD, exercise, IPC + Placebo LLLT

Baseline, post-intervention

Limb volume: water volumetry

Significant difference in favor of LLLT

Adjunctive intervention: elastic taping (ET)

Pekyavas,—included in alternative and adjunctive categories [33]

Turkey

Upper limb

N = 30 BCRL

LE: Stage II or III LE

n = 15

Age: 58.0 (8.5) years

CDT: daily, 10-day treatment with ET applied under CB

Maintenance: self-massage, exercise, and CG

n = 15

Age: 49.6 (10.5) years

CDT: daily, 10-day treatment period

Maintenance: self-massage, exercise, and CG

Baseline, post-intervention (Day 10), and 1-month post-intervention follow-up

Limb volume calculated from circumference measurements

Analysis of two of three intervention groups

No significant differences between groups post-intervention

Collins, [46]

Ireland

Breast edema

N = 14 females with BCRL

LE: a ratio of ≥ 1.1:1 tissue water difference

n = 7

Age: 64.1 (5.9) years

MLD × 20 min, 1x/ week for 3 weeks + ET for two 7-day periods

n = 7

Age: 53.9 (10.4) years

MLD × 20 min, 1x/ week for 3 weeks

Baseline, post-intervention (2 weeks), and 6-week post-intervention follow-up

Breast percentage tissue water

Measures of variability not reported

No between group analyses reported

Atar, [45]

Turkey

Head & Neck

N = 58 with HNL

Males: 35; Females: 23

LE: edema ≥ 3 months; excluded MDACC HNL scale levels 0 and 3

n = 30

Age: 51.5 (7.7) years

Daily MLD × 1 week, then MLD 2 × per week for 3 weeks; daily exercise × 4 weeks; ET applied daily × 1 week, then 3x/ week for 3 weeks. Maintenance: daily home exercises week 5–8

n = 28

Age: 51.1 (8.8) years

Daily MLD × 1 week, then MLD 2 × per week for 3 weeks; daily exercise × 4 weeks; sham ET applied daily × 1 week, then 3x/ week for 3 weeks. Maintenance: daily home exercises week 5–8

Baseline, post-intervention and 8-week follow-up

Tape measurements for external LE; Fiber endoscopic images for internal LE analyzed into categories

Data analyzed for total circumference

A significant benefit found in favor of ET group for external LE

Stand-alone intervention: low level laser therapy (LLLT)

Carati, [48]

Australia

Upper limb

N = 61 females with BCRL

LE: > 200 ml difference or

≥ 2 cm difference circumference at 3 points

n = 33

Age: 65 (2) years

LLLT: 9 sessions (3x/ week for 3 weeks) with 17 treatment points (17 min) @ dosage of 1.5 Joules/cm²

n = 28

Age: 63 (2) years

Sham LLLT: 9 sessions (3x/ week for 3 weeks) with 17 treatment points—no laser delivered

Baseline, post-intervention (3 weeks), 1-month, and 2–3-month post-intervention follow-up

Limb volume: perometry

No data to allow for analysis prior to cross-over

Significant benefit in favor of LLLT at follow-up

Lau, [50]

China

Upper limb

N = 21 females with BCRL

LE: > 200 mL difference

n = 11

Age: 50.9 (8.6) years

LLLT: 12 sessions—3x/ week for 20 min for 4 weeks; 50 cm laser head for 144cm² area; @ dosage 2 Joules/cm²

n = 10

Age: 51.3 (8.9) years

Control: no intervention

Baseline, post-intervention (4 weeks), 4-weeks post-intervention follow-up

Limb volume: water volumetry

No significant difference between the groups post-intervention; Significant benefit in favor of laser therapy at follow-up

Storz, [54]

Germany

Upper limb

N = 36 females with BCRL

LE: 3-month history of LE

n = 17

Age: 61.1 (9.7) years

LLLT: 8 sessions—2x/ week for 4 weeks for 10 min; 4.9 cm² treatment head; 78.54 cm² treatment area @ dosage of 4.89 Joules/cm²

n = 19

Age: 59.4 (10.2) years

Placebo LLLT

Baseline, post-intervention (4 weeks), 4, 8, 12 weeks post-intervention follow-up

Limb volume calculated from circumference measurements

No data on mean or standard deviation

No significant differences between the groups post-intervention or at any follow-up

Stand-alone intervention: elastic taping (ET)

Malicka, [51]

Poland

Upper limb

N = 28 females with early-stage BCRL

LE: Grade 1 lymphedema

N = 14

60.1 (6.3)

Intervention details: ET (two subgroups: 1) upper extremity with single fan shapes; 2) upper extremity in a double fan shape with arm and forearm); applied 1x/week × 4 weeks

N = 14

59.5 (5.7)

Intervention details: no treatment

Baseline, 2 weeks, and post-intervention (4 weeks)

Limb volume calculated from circumference measurements

Within-group difference for ET group; between-group differences not presented

Stand-alone mixed interventions

Abdelhalim, [47]

Egypt

Upper limb

N = 43 females with BCRL

LE: difference of 2 to 8 cm at a single measurement site between arms

n = 21

Age: 48.7 (3.1)

ESWT 2500 shocks per session @ frequency of 4 Hz and flow density of 90 mJ; 3x/ week for 4 weeks (12 sessions)

Daily home program: range of motion, pumping exercises and elevation

n = 22

Age: 49.6 (2.8)

IPC (60 mmHg) for 45 min, 5 times/week for 4 weeks (20 sessions)

Daily home program: range of motion, pumping exercises and elevation

Baseline and post-intervention (4 weeks)

Circumference measurements

No data on limb volume

Significant difference between groups at 4 measurement levels favouring ESWT group

Maintenance: night-time compression

Mestre, [53]

France

Upper Limb

N = 40 females with BCRL post intensive CDT

LE: eligible if a > 10% reduction in Phase I CDT

n = 20; Age: 65.1 (8.6)

Daytime CG (Class I or II) + Night-time Compression system

n = 20; Age: 68.9 (11.8)

Daytime CG (Class I or II)

Baseline, then Day 30 and Day 90 (fast-track Day 30 to 90)

Limb volume calculated from circumference measurements

At Day 30 post-intervention: no significant differences between groups

McNeely, [52]

Canada

Upper limb

N = 120 females with BCRL

LE: ≥ 200 ml or ≥ 10% difference between limbs

n = 44; Age: 62 (9)

Education, Daytime CG (Class II) + Night-time CB Group: 8 h/ night for 5 nights x 6wks, then 3 nights × 6 wks

n = 37; Age: 62 (12)

Education, Daytime CG (Class II) + Night-time Compression System Group: 8 h for 5 nights/wk for 6wks, then 8 h × 3 nights/wk for 6 wks

n = 39; Age: 59 (11)

Standard care: Education + Day-time CG (Class II)

Baseline and then 6, 12, 18, 24 weeks (fast-track from 12–24 weeks)

Limb volume: perometry

At 12-weeks post-intervention: significant benefit in favour of NCSG and CB groups vs comparison group

Maintenance: compression pump

Fife, [49]

United States

Upper Limb

N = 36

LE: eligible if ≥ 5% excess volume

n = 18; Age: 63.9 (12.2)

Advanced pneumatic compression device including arm, adjacent chest, and truncal quadrant: home treatment 60 min/ day for 12-weeks @ a pressure between 9 and 13 mmHg

n = 18; Age: 59.7 (12.6)

Standard pneumatic compression device with 4 chambers for arm: home treatment 60 min /day for 12-weeks @ pressure of 30 mmHg

Baseline, and then 12-weeks post-intervention

Limb volume calculated from circumference measurements

At 12-weeks post-intervention: significant benefit in favor of Advanced Pneumatic Compression

Rockson, [55]

United States

Upper Limb

N = 50 females with BCRL

LE: diagnosis of upper limb lymphedema

n = 23; Age: 60.5 (10.8)

CG + Non-pneumatic wearable compression system for a minimum of 60 min/ day for 28 days

n = 27; Age: 60.3 (10.8)

CG + Advanced pneumatic compression for a minimum of 60 min/ day for 28 days

Baseline, then Day 28 post-intervention

Limb volume calculated from circumference measurements

At Day 28: analyses based on published data suggest borderline significance

Age mean years and standard deviation/range, ALND axillary lymph node dissection, BCRL breast cancer-related lymphedema, CB multicomponent compression bandaging, CDT complete decongestive therapy, CG compression garment, ESWT extracorporeal shockwave therapy, HNL head and neck cancer lymphedema, ET Elastic Taping, LE lymphedema, LLLT low level laser therapy, MLD manual lymph drainage, MDACC HNL MD Anderson Cancer Centre Head and Neck Lymphedema Scale

*Measures of variability from Li, et al. (2022)