Table 4.
Summary and comparison of current acupuncture studies in patients with BCRL
| Author year | Study design | Primary end-point | Sample size | Patientdemo-graphics | Pre-existing lymphedema | Lymphedema measures | Control arm | Current therapy | Acupuncture frequency and duration | Acupuncture techniques | Safety | Lymphedema reduction | Lymphedema-associated symptoms |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Alem [5] | Case series | Improvement of ROM | 29 | Brazil | ≥2 cm arm circumference differences between two arms | Palpation and visual inspection | None | Not allowed | Weekly × 24 weeks | Manual acupuncture at CV12, CV3, CV2 and LI15, TE14, LU5, TE5, LI4, ST36, SP9, and SP6 on the unaffected side | Not reported | Yes p = 0.016 | Improved ROM p< 0.001 |
| Cassileth [30] | Single arm | Safety and tolerability | 33 | United States | ≥2 cm arm circumference differences between two arms | Two-point arm circumference | None | CDT allowed | Twice weekly × 4 weeks | Manual acupuncture at CV12, CV3, and bilateral TE14, LI15, LU5, LI4, ST36, and SP6 | Yes | Yes 35% had more than 30% > reduction | Not reported |
| Smith [33] | Randomized controlled | Safety and feasibility | 20 | Australia | ≥ 10 cm segment by bioimpedance | Bioimpedance | Yes | Usual care No CDT allowed | Twice weekly × 4 weeks then once weekly × 4 weeks | Manual acupuncture at CV12, CV3 CV2, LI15, TE4, LU5, and LI4 on unaffected side; bilateral ST36, SP9, and SP6 | Yes | No difference | No difference |
| Jeong [34] | Single arm observational | Safety and feasibility | 9 | Korea | ≥2 cm arm circumference differences between two arms | Visual Analog Scale | None | Entelon | Three times per week × 6 weeks | Individualized manual acupuncture based on 4 syndromes. No needles on the affected side. | Yes | Yes p< 0.001 | Not aggravated |
| Yao [35] | Randomized controlled | Reduction of lymphedema | 30 | China | ≥3 cm arm circumference differences between two arms | One-point arm circumference | Yes; Diosmin | Moxibustion | Three times per week × 30 days | Manual acupuncture at LI10, LI11, LI14, LI15, SJ5, SJ 14 on the affected side. Moxa applied at SJ5, LI15, and SJ14. | Yes | Yes p< 0.00001 | Improved ROM p <0.05 |
| Our study 2017 | Randomized, wait-list-controlled | Reduction of lymphedema | 82 | United States | ≥2 cm arm circumference differences between two arms | Two-point arm circumference | Yes; CDT | CDT allowed | Twice weekly × 6 weeks | Manual acupuncture at CV12, CV3 and bilateral TE14, LI15, LU5, LI4, ST36, and SP6 | Yes | No difference, but trend favored acupuncture | Not reported |