1. 2015;18;365-372Sympathetic Block as a New Treatment for Lymphedema
   Retrospective Study
   Francis Sahngun Nahm, MD, Eunjoo Choi, MD, and Pyung-Bok Lee, MD, PhD.

BACKGROUND: Breast cancer-related lymphedema (BCRL) not only has physical implications, but also affects the quality of life in breast cancer survivors. Despite numerous studies of various therapies, the optimal treatment for BCRL is unknown.

OBJECTIVE: In this study, we investigated the efficacy of sympathetic blockade (thoracic sympathetic ganglion block, [TSGB]) in treating BCRL.

STUDY DESIGN: Retrospective study.

SETTING: Tertiary referral center/teaching hospital.

METHODS: TSGB was performed in 35 patients under fluoroscopic guidance. First, arm circumference and Lymphedema and Breast Cancer Questionnaire [LBCQ] score were assessed before TSGB and 2 weeks and 2 months after the procedure. Efficacy was defined as a = 50% reduction in the LBCQ score and a = 50% decrease in the circumference difference between the unaffected and affected arms 2 months after TSGB. Second, TSGB efficacy according to the lymphedema stage and the period between BCRL onset and TSGB (< 6 months vs. > 6 months) was evaluated.

RESULTS: The arm circumference and LBCQ score significantly decreased at 2 months (P < 0.001), and 65.7% of patients showed good efficacy. Patients with high stage lymphedema showed improved efficacy after TSGB compared to those with low stage disease (P = 0.045). The TSGB efficacy did not differ according to the period between BCRL onset and TSGB.

LIMITATIONS: This study was not a randomized prospective controlled study and did not compare the therapeutic outcomes to those in a conservative treatment group.

CONCLUSIONS: TSGB in BCRL patients appears to be effective in decreasing the affected arm circumference. TSGB may be an alternative option in BCRL patients who do not respond to conservative therapy.