Eur J Dermatol 2006 May 1; 16(3): 290-292 (Read article online)

Aguiar Bujanda D, Camacho Galán R, Bastida Iñarrea J, Aguiar Morales J, Conde Martel A, Rivero Suárez P, de Armas Diaz F, Bohn Sarmiento U, Angel Cabrera Suárez M

Angiosarcoma is a rare malignant tumor, with a predilection for skin in the head and neck region, although it has been described in many other locations. Its association with chronic lymphedema is well known, mainly in the setting of postmastectomy lymphedema of the arm in breast cancer patients (termed Stewart-Treves syndrome). However, angiosarcoma can appear in lower limbs with chronic lymphedema and rarely in other locations such as the abdominal wall. Herein, we present a unique case of angiosarcoma developing in the abdominal wall of a morbidly obese patient after extensive dermolipectomy.

Int J Dermatol 2006 May; 45(5): 499-503 (Read article online)

Shehan JM, Ahmed I

Abstract Background Despite common endothelial origins, angiosarcoma and Kaposi's sarcoma are clinically and histologically distinct vascular proliferations. The development of angiosarcoma in a chronically edematous abdominal pannus is extremely uncommon. Similarly, tumors with the combined histologic features of angiosarcoma and Kaposi's sarcoma have rarely been described. Methods We reviewed the literature on angiosarcoma arising in a lymphedematous abdominal pannus and evaluated an 81-year-old morbidly obese woman who had profound, long-standing edema of the lower abdominal wall in which an aggressive vascular tumor developed. Results Three clinically similar cases were identified in the literature. All patients were women who generally experienced rapid disease progression. In addition, in our patient, sequential cutaneous sampling from different lesional sites demonstrated disparate histologic changes, ranging from those of classic Kaposi's sarcoma to high-grade angiosarcoma, to areas with combined features of the two tumors. A polymerase chain reaction performed on lesional tissue was negative for human herpesvirus-8 DNA. Conclusion It is important to note that angiosarcoma may develop in the abdomen in association with chronic lymphedema, as demonstrated by the cases noted in this report. In addition, our case highlights the difficulty in differentiating histologically angiosarcoma from Kaposi's sarcoma in some situations, and demonstrates the value of close clinicopathologic correlation and sequential tissue sampling in evaluating problematic cases.

J Clin Oncol 2006 May 15; (Read article online)

Ahmed RL, Thomas W, Yee D, Schmitz KH

PURPOSE: Lymphedema is a common condition that breast cancer survivors face. Despite a lack of supporting evidence from prospective observational studies, occupational and leisure time physical activity are feared to be possible risk factors for lymphedema onset or exacerbation. We examined effects of supervised upper- and lower-body weight training on the incidence and symptoms of lymphedema in 45 breast cancer survivors who participated in the Weight Training for Breast Cancer Survivors study. METHODS: Participants were on average 52 years old, 4 to 36 months post-treatment, and had axillary dissection as part of their treatment. Thirteen women had prevalent lymphedema at baseline. The intervention was twice-a-week weight training over a period of 6 months. Lymphedema was monitored at baseline and 6 months by measuring the circumference of each arm, and by self-report of symptoms and clinical diagnosis. RESULTS: None of the intervention-group participants experienced a change in arm circumferences >/= 2.0 cm after a 6-month exercise intervention. Self-reported incidence of a clinical diagnosis of lymphedema or symptom changes over 6 months did not vary by intervention status (P = .40 and P = .22, respectively). CONCLUSION: This is the largest randomized controlled trial to examine associations between exercise and lymphedema in breast cancer survivors. The results of this study support the hypotheses that a 6-month intervention of resistance exercise did not increase the risk for or exacerbate symptoms of lymphedema. These results herald the need to start reevaluating common clinical guidelines that breast cancer survivors avoid upper body resistance activity for fear of increasing risk of lymphedema.

Int J Gynecol Cancer 2006 Mar-Apr; 16(2): 908-11 (Read article online)

Micha JP, Goldstein BH, Rettenmaier MA, Brown JV, Bock BV

Spontaneous bacterial peritonitis (SBP) is an acute bacterial infection usually associated with ascites and cirrhosis or is a complication of peritoneal dialysis. There are very few case reports of cancer patients who developed this disease. Furthermore, there have been no published case reports of successfully treated gynecological cancer patients who later developed SBP. We present a case involving a 41-year-old woman who was treated for cervical carcinoma in 1992. She underwent radical surgery and adjuvant chemoradiation therapy. Two years later, the patient presented with streptococcal group B cellulitis associated with left leg lymphedema. She recovered following antibiotic treatment but had recurrent episodes of streptococcal cellulitis in her leg over the past 10 years. In 2003, the patient was admitted to the hospital because of sepsis, acute renal failure, and SBP. She was treated and recovered following treatment. SBP is usually associated with cirrhosis. Although SBP is rarely seen in successfully treated gynecological cancer patients, oncologists should be aware of this clinical entity. Timely treatment is essential to maximize chances of survival.

Exp Dermatol 2006 Jun; 15(6): 478 (Read article online)

Zouboulis CC

Hidradenitis suppurativa (HS)/acne inversa (AI) is a chronic, recurrent, debilitating skin disease that presents with painful, inflamed lesions in the apocrine gland-bearing areas of the body, most commonly the axillary, inguinal, and anogenital areas. The disorder is associated with several clinical disputes, such as the discussion on the exact skin appendage involved, namely the sweat glands, the apocrine glands or the terminal hair follicles, and the discussion on the pathogenetic background, namely a genetic, hormonal, bacterial, genuine inflammatory, environmental, or physical one. The significance of gender, body mass, and smoking on disease prevalence is still under investigation. Moreover, the major challenge is the choice of the optimal treatment: antibiotics, retinoids, corticosteroids, incision and drainage, local wound care, limited or radical local excision, radiation, laser therapy, and modern drugs, such as biologics, have been proposed. The psychological impact on the patient can be great, encompassing social, personal, and occupational challenges. The sequelae of the disease, including dermal contraction, keloid formation, restricted limb mobility, lymphedema, and fistula formation dominate the long-term burden associated with patient's quality of life. Significant research is required to elucidate the etiology of HS/AI, classify the clinical picture, identify appropriate drug candidates, and evaluate the social, economic, and psychological impact of the disease.

J Palliat Care 2006; 22(1): 5-11 (Read article online)

Frid M, Strang P, Friedrichsen MJ, Johansson K

Lower limb lymphedema (LLL) is a common but neglected problem in palliative cancer patients. No studies have focused on these patients' experiences of lymphedema. The aims of this study were to explore patients' experiences regarding LLL and how they manage to deal with this in the late palliative stage. METHODS: Thirteen patients with cancer-related LLL were included to satisfy a maximum variation sampling strategy. Interviews were analyzed using a qualitative phenomenographic method. RESULTS: LLL influenced the patients' thoughts about the future. Body image was often strongly influenced. Interactions with other persons were perceived as both positive and negative, and a range of coping strategies were expressed. CONCLUSION: LLL can exert a considerable influence on the physical experiences and the psychosocial situation of cancer patients in palliative care. Areas in need of increased education, attention, and further research are highlighted.

J Natl Cancer Inst 2006 May 3; 98(9): 599-609 (Read article online)

Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, Yiangou C, Horgan K, Bundred N, Monypenny I, England D, Sibbering M, Abdullah TI, Barr L, Chetty U, Sinnett DH, Fleissig A, Clarke D, Ell PJ

BACKGROUND: Sentinel lymph node biopsy in women with operable breast cancer is routinely used in some countries for staging the axilla despite limited data from randomized trials on morbidity and mortality outcomes. We conducted a multicenter randomized trial to compare quality-of-life outcomes between patients with clinically node-negative invasive breast cancer who received sentinel lymph node biopsy and patients who received standard axillary treatment. METHODS: The primary outcome measures were arm and shoulder morbidity and quality of life. From November 1999 to October 2003, 1031 patients were randomly assigned to undergo sentinel lymph node biopsy (n = 515) or standard axillary surgery (n = 516). Patients with sentinel lymph node metastases proceeded to delayed axillary clearance or received axillary radiotherapy (depending on the protocol at the treating institution). Intention-to-treat analyses of data at 1, 3, 6, and 12 months after surgery are presented. All statistical tests were two-sided. RESULTS: The relative risks of any lymphedema and sensory loss for the sentinel lymph node biopsy group compared with the standard axillary treatment group at 12 months were 0.37 (95% confidence interval [CI] = 0.23 to 0.60; absolute rates: 5% versus 13%) and 0.37 (95% CI = 0.27 to 0.50; absolute rates: 11% versus 31%), respectively. Drain usage, length of hospital stay, and time to resumption of normal day-to-day activities after surgery were statistically significantly lower in the sentinel lymph node biopsy group (all P < .001), and axillary operative time was reduced (P = .055). Overall patient-recorded quality of life and arm functioning scores were statistically significantly better in the sentinel lymph node biopsy group throughout (all P < or = .003). These benefits were seen with no increase in anxiety levels in the sentinel lymph node biopsy group (P > .05). CONCLUSION: Sentinel lymph node biopsy is associated with reduced arm morbidity and better quality of life than standard axillary treatment and should be the treatment of choice for patients who have early-stage breast cancer with clinically negative nodes.

Urol Int 2006; 76(4): 335-8 (Read article online)

Varga Z, Hegele A, Olbert P, Hofmann R, Schrader AJ

Background: Lymphoceles are frequent complications of pelvic lymph node dissection. While small lymphoceles often remain undetected, larger ones can cause complications and require further treatment, e.g. percutaneous tube drainage alone or in combination with sclerotherapy. However, recurrence rates are considerable, and long-lasting drainage may lead to infection, prolonged hospitalization, and as a consequence, increased overall costs. We report the results of a simplified laparoscopic approach to drain lymphoceles after radical prostatectomy plus pelvic lymphadenectomy using methylene blue instillation. Methods: 13 patients with large symptomatic pelvic/retroperitoneal lymphoceles refractory to percutaneous tube drainage and doxycycline sclerotherapy received a laparoscopic transperitoneal marsupialization following instillation of a sterile diluted methylene blue solution into the drained cavity to refill and mark the lymphocele. Results: All lymphoceles were sterile and ranged in size from 7 x 6 x 4 to 15 x 12 x 6 cm. Clinical symptoms included lower abdominal swelling, tenderness in the iliac fossa, ipsilateral lymphedema, deep venous thrombosis, wound fistula, and hydronephrosis due to ureteral obstruction. After methylene blue instillation, the lymphoceles were easily identified and opened. Median total operative time was 50 (range 25-70) min; blood loss was negligible. There was one complication in the form of a metachronous infection in the operating field and no relapses. Patients were discharged 1-5 (median 3) days after the surgical procedure. Conclusions: Laparoscopic peritoneal drainage requires greater operative skill than percutaneous approaches. However, the instillation of a methylene blue solution simplifies this procedure as the extent and location of the lymphoceles can be precisely identified during laparoscopy. We recommend early application of laparoscopic peritoneal drainage following methylene blue instillation for patients with sterile lymphoceles after pelvic lymph node dissection in whom temporary percutaneous drainage and sclerotherapy failed to resolve the lymph fluid collection. Copyright (c) 2006 S. Karger AG, Basel.

Health Expect 2006 Jun; 9(2): 158-73 (Read article online)

Gould J, Grassau P, Manthorne J, Gray RE, Fitch MI

Abstract Objective There exists little research about the experience of breast cancer for young women in Canada. To address this gap, the Canadian Breast Cancer Network (CBCN) and the Ontario Breast Cancer Community Research Initiative undertook a research project to explore the information and support experiences, needs and recommendations of geographically diverse Canadian young women with breast cancer. Setting and participants We consulted with 65 young women in 10 focus groups held across Canada. All women had been diagnosed with breast cancer at, or before, 45 years of age. During the consultations the women were asked to discuss their information and support experiences and needs, as well as resource recommendations related to their diagnosis, treatment and survivorship. Main results The overarching theme, 'Nothing Fit Me', revealed that accessed information, support and programmes/services did not 'fit' or match the women's age or life stage. When we asked for their recommendations the young women suggested that information and support match their age and life stage and that health-care providers create and implement several topical workshops concerning, for example, sexuality, lymphedema and reconstruction. Conclusion The findings will be used by the CBCN as a general platform from which to conduct further research and/or action strategies. The CBCN will also implement the recommendations from this groundbreaking work as this network formulates a national strategy for young women with breast cancer.

Lasers Med Sci 2006 May 4; (Read article online)

Kaviani A, Fateh M, Nooraie RY, Alinagi-Zadeh MR, Ataie-Fashtami L

The aim of this paper was to study the effects of low-level laser therapy (LLLT) in the treatment of postmastectomy lymphedema. Eleven women with unilateral postmastectomy lymphedema were enrolled in a double-blind controlled trial. Patients were randomly assigned to laser and sham groups and received laser or placebo irradiation (Ga-As laser device with a wavelength of 890 nm and fluence of 1.5 J/cm(2)) over the arm and axillary areas. Changes in patients' limb circumference, pain score, range of motion, heaviness of the affected limb, and desire to continue the treatment were measured before the treatment and at follow-up sessions (weeks 3, 9, 12, 18, and 22) and were compared to pretreatment values. Results showed that of the 11 enrolled patients, eight completed the treatment sessions. Reduction in limb circumference was detected in both groups, although it was more pronounced in the laser group up to the end of 22nd week. Desire to continue treatment at each session and baseline score in the laser group was greater than in the sham group in all sessions. Pain reduction in the laser group was more than in the sham group except for the weeks 3 and 9. No substantial differences were seen in other two parameters between the two treatment groups. In conclusion, despite our encouraging results, further studies of the effects of LLLT in management of postmastectomy lymphedema should be undertaken to determine the optimal physiological and physical parameters to obtain the most effective clinical response.

Eur J Radiol 2006 Apr 16; (Read article online)

Lohrmann C, Foeldi E, Langer M

PURPOSE: To assess the feasibility of indirect magnetic resonance (MR) lymphangiography with intracutaneous injection of gadodiamide, a commercially available, non-ionic, extracellular paramagnetic contrast agent for the detection of lymphatic vessels in patients with lymphedema. MATERIALS AND METHODS: In 2005, three patients with lymphedema of the lower extremities (1 primary, 2 secondary) were referred by the Foeldi Clinic for Lymphology for indirect magnetic resonance lymphangiography. 4.5mL of gadodiamide and 0.5mL of mepivacainhydrochloride 1% were injected intracutaneously into the dorsal aspect of each foot. MR imaging was performed with a 1.5-T system equipped with high-performance gradients. For indirect magnetic resonance lymphangiography, a 3D Fast Low Angle Shot (FLASH) sequence (TR/TE: 5.1/1.23; flip angle: 25; matrix: 448x448; bandwidth: 330Hz/pixel; 6/8 rectangular field of view with a maximum dimension of 500mm; slices: 88; voxel size: 2.0mmx1.0mmx1.0mm; acquisition time: 0min 31s) was used. RESULTS: Indirect magnetic resonance lymphangiography depicted lymphatic vessels of the lower and upper leg, and inguinal lymph nodes in all three patients. After 5min of contrast material application, concomitant venous enhancement was detected. Collateral vessels with dermal back-flow were seen in two patients. A lymphocele in the inguinal region with the afferent lymphatic vessel was depicted in one patient. CONCLUSION: In the presented small study group, indirect magnetic resonance lymphangiography was technically feasible, and no complications were observed after intracutaneous injection of gadodiamide. Visualizing the lymphatic vessels and accompanying complications non-invasively and without the use of radiation, the presented method has the capability to become a routine diagnostic imaging tool in patients with primary and secondary lymphedema. The method is not able to characterize lymph node morphology, but could provide additional information about the lymphatic vessels when lymph nodes are examined, e.g. with super-paramagnetic iron oxide particles.

Plast Reconstr Surg 2006 Apr 15; 117(5): 1576-83 (Read article online)

Kim JY, Ross MI, Butler CE

BACKGROUND: Recurrent axillary metastasis following axillary lymphadenectomy for melanoma is associated with a poor prognosis. Radical resection of such axillary recurrences with concomitant reconstruction may not only yield significant palliation of symptoms but also improve disease-free survival. The purpose of this study was to evaluate the outcomes of this radical surgical approach and help determine the risks and benefits for this patient population. METHODS: A retrospective review of all patients who underwent axillary reexcision and reconstruction for metastatic melanoma between 1990 and 2000 was conducted at The University of Texas M. D. Anderson Cancer Center. Nine patients were identified who underwent flap reconstruction following radical excision of axillary recurrence after a previous lymphadenectomy. RESULTS: A total of 14 flaps were performed on the nine patients (five free flaps and nine pedicled muscle or myocutaneous flaps). Indications for surgery included pain, bleeding, and infection. Seven of the nine patients received perioperative radiation therapy. Palliation of symptoms was achieved in all patients. Free flap survival was 100 percent. Complications occurred in four of nine patients and included seroma, lymphedema, and wound dehiscence. Three patients had second local recurrences necessitating reresection and reconstruction; the mean time to rerecurrence was 6.7 months (range, 2 to 12 months). Four of nine patients were alive with no evidence of disease at the end of the follow-up period, with a mean disease-free interval of 41 months (range, 5 to 77 months). One patient was alive with distant metastasis, and four patients had died of distant metastases. The mean disease-free interval following original lymphedema for the nine patients was 11 months (range, 2 to 40 months). CONCLUSIONS: Aggressive resection of axillary recurrence following lymphadenectomy can palliate symptoms in select individuals and may result in long-term disease-free survival. Critical to this evolving surgical strategy is the use of vascularized soft tissue in the form of pedicled or free flaps to provide durable coverage of the resulting resection defect.

Wound Repair Regen 2006 Mar-Apr; 14(2): 110-8 (Read article online)

Franks PJ, Moffatt CJ, Doherty DC, Williams AF, Jeffs E, Mortimer PS

The purpose of this study was to examine the use of a number of tools in the evaluation of health-related quality of life in patients with lower limb lymphedema, and to determine the consequences of cancer history and concurrent leg ulceration. Patients in one health trust having lower limb lymphedema were identified and interviewed at entry and after 24 weeks. The short form-36 (SF-36), modified Barthel scale, McGill short form pain questionnaire, and Euroqol were administered at both time points. Of the 164 (median age=76.9 years, 70.7% women) patients who comprised the study population, 15.2% had a history of cancer and 30.4% had coexisting current leg ulceration. Internal consistencies were high for all scales (Cronbach's alpha >0.80). There were high ceiling effects for a number of SF-36 scores, and high floor effects in these and the McGill short form pain questionaire, scales. Despite these limitations, there was strong evidence that treatment led to significant improvements in six of eight scores of the SF-36, three of three scores of the McGill short form pain questionnaire and the modified Barthel scale (all p<0.05). The improvement in physical functioning was significantly greater for patients who entered the study with a leg ulcer (mean different=9.1, 95% confidence interval 2.1-16.1, p=0.011). Patients treated with compression bandaging had significantly greater improvements for physical functioning (10.2) than those treated with compression hoisery (-1.5) or no treatment (-2.0), p=0.001. Of the tools assessed, the SF-36, appears to be the most appropriate for use in this patient group.

Curr Med Chem 2006; 13(7): 783-92 (Read article online)

Stacker SA, Hughes RA, Williams RA, Achen MG

The recent discovery that members of the vascular endothelial growth factor (VEGF) family of secreted glycoproteins can mediate lymphatic vessel growth (lymphangiogenesis) via cell surface receptor tyrosine kinases expressed on endothelial cells has opened the way for therapeutic intervention for pathologies involving dysregulated lymphatic vessel function. At least two members of this family, VEGF-C and VEGF-D, have been shown to induce lymphangiogenesis in vivo. Lymphatic vessels and their specific growth factors have been directly implicated in a number of significant human pathologies. In cancer, VEGF-C and VEGF-D appear to correlate with tumor metastasis and poor patient outcome in a range of prevalent human cancers. Experimental studies have demonstrated that expression of the lymphangiogenic growth factors in tumor models induces increased lymphangiogenesis and results in spread of tumor cells via the lymphatics. In contrast, conditions such as lymphedema, where lymphatic vessels fail to clear fluid from interstitial spaces, are opportunities for which the application of growth factors to generate new lymphatic vessels may be a viable therapeutic option. The list of molecules that control lymphangiogenesis is now expanding, allowing more opportunities for the development of drugs with which to manipulate the relevant signalling pathways. Modulating these pathways and other molecules with specificity to the lymphatic endothelium could offer alternative treatments for a number of important clinical conditions.

Orv Hetil 2006 Mar 5; 147(9): 401-6 (Read article online)

Kahán Z, Lázár G, Lázár M, Ormándi K, Pálka I, Thurzó L

Breast cancer, the most prevalent female malignancy represents a major health problem. Breast cancer mortality may be halved by high quality mammography screening and care. The most efficient screening and the best treatment of patients are available at the breast centers that are equipped with special facilities, expertise and significant experience via the treatment of a high number of patients. Breast center is a virtual unit based on the collaboration of various professionals; a tight institutional frame is not a must. In these comprehensive centers, 150 breast cancer patients per year at a minimum are treated, and the most efficient special treatment methods are available. The core members of the staff are the breast pathologists, the mammographists, the breast surgeons, the oncologists/oncoradiologists, the breast nurses, the technicians and the data managers. An easy access to the service of the non-core members, the plastic surgeons, the psychologists, the psychiatrists and the clinical geneticists is necessary. An optimal collaboration of the various experts may be achieved by a training of the members, regular multidisciplinary meetings and guidelines developed and accepted by all. The requirements of a breast center have been published by the European Society of Mastology (EUSOMA), and a directory of the accredited European breast centers is maintained. The Breast Unit of the University of Szeged has been found eligible by EUSOMA to be included in the directory of the European breast units. Two mammographists do screening-mammography and clinical examination, 2 pathologists perform cytopathological, histopathological and immunohistochemical examinations. Three surgeons operate on more than 250 breast cancer patients per year, and apply wire or isotope (ROLL) localisation in case of non-palpable lesion. A plastic surgeon is available if necessary. In a half of all cases, sentinel mapping is performed with isotope- and blue dye-labelling. Two radiotherapists apply conformal radiotherapy in 250 cases per year, and 2 oncologists perform modern chemotherapies in 200 cases as a yearly avarage; 50 new advanced/metastatic cases per year require oncological treatments. Breast nurses, a psycho-oncologist and a mental hygienist nurse assist the team. There is access to lymphedema treatment and physiotherapy. The final goal of the program is to provide all women with high quality mammography screening and care, if necessary.

AJR Am J Roentgenol 2006 May; 186(5): 1349-55 (Read article online)

O'mahony S, Solanki CK, Barber RW, Mortimer PS, Purushotham AD, Peters AM

OBJECTIVE: The disordered physiology that results from axillary lymph node clearance surgery for breast cancer and that leads to breast cancer-related lymphedema is poorly understood. Rerouting of lymph around the axilla or through new pathways in the axilla may protect women from breast cancer-related lymphedema. The aim of the study was to compare intradermal with subcutaneous injection of technetium-99m ((99m)Tc)-labeled human polyclonal IgG (HIG) with respect to lymphatic vessel imaging. MATERIALS AND METHODS: Six women with breast cancer-related lymphedema underwent unilateral upper limb lymphoscintigraphy, using a web space injection of (99m)Tc-labeled HIG, after intradermal and subcutaneous injections on separate occasions. Multiple sequential images were obtained of the affected upper limb and torso over 3 hr on each occasion. Accumulation of activity in blood was quantified from venous blood samples taken from the opposite arm. RESULTS: Imaging after intradermal injection clearly showed discrete lymphatic vessels in five of six patients, in contrast to imaging after subcutaneous injection, which did not show any discrete vessels in any patient. Intradermal injection resulted in more rapid visualization of cutaneous lymph rerouting than subcutaneous injection in six of six patients. Recovery of injected (99m)Tc-labeled HIG in venous blood was greater after intradermal injection in six of six patients. CONCLUSION: In patients with breast cancer-related lymphedema, lymphatic vessels are more clearly depicted after intradermal than subcutaneous injection as a result of direct access of radiotracer to dermal lymphatics. This finding has implications for imaging lymphatic vessel regeneration and lymph rerouting.

Am J Trop Med Hyg 2006 Mar; 74(3): 500-4 (Read article online)

McPherson T, Fay MP, Singh S, Penzer R, Hay R

Severity of lymphedema and presence of entry lesions are risk factors for acute bacterial dermatolym-phangioadenitis (ADLA) in those with filarial lymphedema. Recurrent ADLA causes acute morbidity and progression of lymphedema severity; however, there is little work assessing the ability of health workers to reliably stage disease severity and identify risk entry lesions. This knowledge is important in initiation of management and assessing interventions. We evaluated inter-rater reliability with two independent health workers rating both legs of 17 patients using a questionnaire and the Dreyer classification of lymphedema. The health workers could reliably stage lymphedema with high agreement (RMAC weighted kappa of 0.89) and identify nail, interdigital, and other skin lesions. However, there was less consistency in identifying the clinical nature of skin lesions. This indicates that the Dreyer classification can be a replicable way to stage lymphedema and a questionnaire can deliver high observer agreement on the presence of risk lesions.

Lymphology 2005 Dec; 38(4): 167-80 (Read article online)

Johansson K, Tibe K, Weibull A, Newton RC

Clinical trials of the effect of physical exercise on breast cancer related arm lymphedema (ALE) are very rare. The aim of this study was to examine if controlled low intensity arm exercises with weights, with or without a compression sleeve, influence breast cancer related ALE. Thirty-one breast cancer treated patients with small or moderate ALE were included in the study. A specifically designed arm exercise program was performed with or without compression sleeve on different days and in a randomized order. Measurements were performed before, directly after and 24 hours after the exercise intervention, with water displacement method and multiple frequency bioelectrical impedance analysis (n=10) for volume of the arms and Borg's scale for perceived exertion during training. There was an increase of total arm volume of the lymphedema arm immediately after the exercise intervention for both with and without sleeve conditions (p < 0.01). At 24 hours, no volume increase was found compared to pre-exercise and both groups showed tendency towards reduced lymphedema relative volume (p < 0.05). The patient's rating of perceived exertion was low regardless of whether a sleeve was worn, but was significantly higher when exercising with the sleeve. We conclude that low intensity exercises can be performed by patients with arm lymphedema without risk of worsening the edema. Exercises without the sleeve may be of benefit provided compression sleeve is worn regularly.

Cancer 2006 Mar 13; (Read article online)

Fardet L, Stoebner PE, Bachelez H, Descamps V, Kerob D, Meunier L, Dandurand M, Morel P, Lebbe C

BACKGROUND: Kaposi sarcoma (KS) is an angioproliferative disease that may represent a difficult therapeutic challenge in disseminated stages. The efficacy of taxanes (paclitaxel and docetaxel), as agents with antiangiogenic properties, has been described previously in the treatment of patients with acquired immunodeficiency syndrome (AIDS)-associated KS but remains unknown in the treatment of patients with refractory or life-threatening KS without human immunodeficiency (HIV) infection. METHODS: During the past 6 years, 12 non-HIV-infected patients with refractory KS were treated with paclitaxel (175 mg/m(2) every 3 wks) or docetaxel (60 mg/m(2) every 3 wks). RESULTS: All patients improved dramatically after chemotherapy. Partial desinfiltration (n = 6) or complete desinfiltration (n = 6) of all papulonodular skin lesions was observed with marked improvement of lymphedema in 6 patients. According to the AIDS Clinical Trials Group criteria, response was partial in 100% of patients. A major response was obtained among patients who had visceral lesions (n = 3 patients), with rapid and complete remission of digestive or respiratory symptoms. The mean delay to response was 2 courses. Treatment was sustained for 3 patients. For the remaining 9 patients who received a median of 7 courses (range, 2-14 courses), the mean time to recurrence or follow-up without recurrence was 13 months. Tolerance was good except for 3 episodes of Grade 3 or 4 asymptomatic neutropenia and 1 episode of moderate myositis. CONCLUSIONS: The results of this study showed that taxanes are beneficial in the treatment of patients with refractory or life-threatening Kaposi sarcoma. Cancer 2006. (c) 2006 American Cancer Society.

J Strength Cond Res 2006 Feb; 20(1): 14-21 (Read article online)

Cheema BS, Gaul CA

This study evaluated the safety and effectiveness of an 8-week full-body resistance and aerobic exercise program for 27 survivors of breast cancer (age, 57.7 +/- 7.2 years; years posttreatment, 0.8- 21.0) with prior upper-body conditioning. Physical fitness and quality-of-life (QOL) measures were obtained before and after the training period. Lymphedema, evaluated via arm volume measurement at baseline, was self-monitored throughout the trial. Sum of skinfolds, waist girth, and hip girth were significantly reduced posttraining (p < 0.01), although body weight did not change. Significant improvements (p < 0.01) were observed in upper-body strength (35.6 +/- 16.4%) and endurance (167.4 +/- 55.4%), lower-body strength (50.7 +/- 32.3%) and endurance (273.1 +/- 120.7%), Vo(2peak), trunk flexibility, and flexibility of the ipsilateral (surgical) and contralateral shoulder joint. Psychological QOL and overall QOL, evaluated via the World Health Organization Quality of Life Assessment Scale-Abbreviated Version. Inventory also improved significantly (p < 0.01). No incidents of lymphedema or injury were reported. These findings suggest that survivors of breast cancer can safely benefit from engaging in a full-body exercise regimen.