Upper extremity lymphedema after radiation therapy, chemotherapy and surgical treatment of breast cancer. Part 2. Treatment, prevention. Review

Despite the advances in the treatment of breast cancer and related complications, the secondary lymphedema of the upper extremities is a very urgent problem. The main directions to study the issue are the ways of effective control of the existing disease, especially at late stages of diseases, charac-terized by a significant increase in the volume of the affected limb and significant development of fibrotic changes, as well as the search for ways to prevent the occurrence of lymphedema at the stage of breast cancer treatment and after it. Many methods of conservative and surgical treatment have been described in the literature. Despite its simplicity, the use of external elastic compression is one of the most common ways to combat lymphedema. The use of compression therapy is indicated for any stage of lymphedema. If conservative treatment is ineffective, various surgical treatments are widely used. Some of them are aimed at reducing the volume of edematous and fibrotic tissues, others are based on reconstruction or replacement of non-functioning parts of the lymphatic system of the upper limb, and there are also combined methods that combine operations of both directions. Preven-tion of lymphedema development after breast cancer treatment, similarly to treatment, should be com-prehensive, taking into account the patient's case history, stage of cancer, surgical intervention or absorbed doses during radiation therapy, and possible adjuvant treatment. There are no genetic de-terminants, predictors of lymphedema complications, therefore, the reasons for complications of this type of treatment should be sought in the imperfection of the methodology of this treatment, causing damage to the lymphatic system. The most important issues are the selection of an effective and safe radiation therapy regimen, a sufficiently radical surgical intervention that is as gentle as possible with respect to the lymphatic outflow system of the limb.