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Published in: Lasers in Medical Science 3/2017

01-04-2017 | Original Article

Efficacy and safety of far infrared radiation in lymphedema treatment: clinical evaluation and laboratory analysis

Authors: Ke Li, Zheng Zhang, Ning Fei Liu, Shao Qing Feng, Yun Tong, Ju Fang Zhang, Joannis Constantinides, Davide Lazzeri, Luca Grassetti, Fabio Nicoli, Yi Xin Zhang

Published in: Lasers in Medical Science | Issue 3/2017

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Abstract

Swelling is the most common symptom of extremities lymphedema. Clinical evaluation and laboratory analysis were conducted after far infrared radiation (FIR) treatment on the main four components of lymphedema: fluid, fat, protein, and hyaluronan. Far infrared radiation is a kind of hyperthermia therapy with several and additional benefits as well as promoting microcirculation flow and improving collateral lymph circumfluence. Although FIR therapy has been applied for several years on thousands of lymphedema patients, there are still few studies that have reported the biological effects of FIR on lymphatic tissue. In this research, we investigate the effects of far infrared rays on the major components of lymphatic tissue. Then, we explore the effectiveness and safety of FIR as a promising treatment modality of lymphedema. A total of 32 patients affected by lymphedema in stage II and III were treated between January 2015 and January 2016 at our department. After therapy, a significant decrease of limb circumference measurements was noted and improving of quality of life was registered. Laboratory examination showed the treatment can also decrease the deposition of fluid, fat, hyaluronan, and protein, improving the swelling condition. We believe FIR treatment could be considered as both an alternative monotherapy and a useful adjunctive to the conservative or surgical lymphedema procedures. Furthermore, the real and significant biological effects of FIR represent possible future applications in wide range of the medical field.
Literature
1.
go back to reference Dunberger G, Lindquist H, Waldenstrom AC, Nyberg T, Steineck G et al (2013) Lower limb lymphedema in gynecological cancer survivors—effect on daily life functioning. Support Care Cancer 21:3063–3070CrossRefPubMed Dunberger G, Lindquist H, Waldenstrom AC, Nyberg T, Steineck G et al (2013) Lower limb lymphedema in gynecological cancer survivors—effect on daily life functioning. Support Care Cancer 21:3063–3070CrossRefPubMed
2.
go back to reference Finnane A, Hayes SC, Obermair A, Janda M (2011) Quality of life of women with lower-limb lymphedema following gynecological cancer. Expert Rev Pharmacoecon Outcomes Res 11:287–297CrossRefPubMed Finnane A, Hayes SC, Obermair A, Janda M (2011) Quality of life of women with lower-limb lymphedema following gynecological cancer. Expert Rev Pharmacoecon Outcomes Res 11:287–297CrossRefPubMed
3.
go back to reference Tiwari P, Coriddi M, Salani R, Povoski SP (2013) Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options. World J Surg Oncol 11:237CrossRefPubMedPubMedCentral Tiwari P, Coriddi M, Salani R, Povoski SP (2013) Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options. World J Surg Oncol 11:237CrossRefPubMedPubMedCentral
4.
go back to reference Döller W (2013) Lymphedema: anatomy, physiology and pathophysiology of lymphedema, definition and classification of lymphedema and lymphatic vascular malformations. Wien Med Wochenschr 163:155–161CrossRefPubMed Döller W (2013) Lymphedema: anatomy, physiology and pathophysiology of lymphedema, definition and classification of lymphedema and lymphatic vascular malformations. Wien Med Wochenschr 163:155–161CrossRefPubMed
6.
go back to reference Murdaca G, Cagnati P, Gulli R, Spano F, Puppo F et al (2012) Current views on diagnostic approach and treatment of lymphedema. Am J Med 125:134–140CrossRefPubMed Murdaca G, Cagnati P, Gulli R, Spano F, Puppo F et al (2012) Current views on diagnostic approach and treatment of lymphedema. Am J Med 125:134–140CrossRefPubMed
7.
go back to reference Felmerer G, Sattler T, Lohrmann C, Tobbia D (2012) Treatment of various secondary lymphedemas by microsurgical lymph vessel transplantation. Microsurgery 32:171–177CrossRefPubMed Felmerer G, Sattler T, Lohrmann C, Tobbia D (2012) Treatment of various secondary lymphedemas by microsurgical lymph vessel transplantation. Microsurgery 32:171–177CrossRefPubMed
8.
go back to reference Dylke ES, Ward LC, Meerkin JD, Nery L, Kilbreath SL (2013) Tissue composition changes and secondary lymphedema. Lymphat Res Biol 11:211–218CrossRefPubMed Dylke ES, Ward LC, Meerkin JD, Nery L, Kilbreath SL (2013) Tissue composition changes and secondary lymphedema. Lymphat Res Biol 11:211–218CrossRefPubMed
9.
go back to reference Lin S, Kim J, Lee MJ, Roche L, Yang NL et al (2012) Prospective transcriptomic pathway analysis of human lymphatic vascular insufficiency: identification and validation of a circulating biomarker panel. PLoS One 7:e52021CrossRefPubMedPubMedCentral Lin S, Kim J, Lee MJ, Roche L, Yang NL et al (2012) Prospective transcriptomic pathway analysis of human lymphatic vascular insufficiency: identification and validation of a circulating biomarker panel. PLoS One 7:e52021CrossRefPubMedPubMedCentral
10.
go back to reference Liu NF, Zhang LR (1998) Changes of tissue fluid hyaluronan (hyaluronic acid) in peripheral lymphedema. Lymphology 31:173–179PubMed Liu NF, Zhang LR (1998) Changes of tissue fluid hyaluronan (hyaluronic acid) in peripheral lymphedema. Lymphology 31:173–179PubMed
11.
go back to reference Liu NF, Zhang LR, Li SL, Cao WG, Zhang DS et al (2004) Metabolism of hyaluronic acid and extremity lymphedema. Zhonghua Zheng Xing Wai Ke Za Zhi 20:113–116PubMed Liu NF, Zhang LR, Li SL, Cao WG, Zhang DS et al (2004) Metabolism of hyaluronic acid and extremity lymphedema. Zhonghua Zheng Xing Wai Ke Za Zhi 20:113–116PubMed
12.
go back to reference Markhus CE, Karlsen TV, Wagner M, Svendsen OS, Tenstad O et al (2013) Increased interstitial protein because of impaired lymph drainage does not induce fibrosis and inflammation in lymphedema. Arterioscler Thromb Vasc Biol 33:266–274CrossRefPubMed Markhus CE, Karlsen TV, Wagner M, Svendsen OS, Tenstad O et al (2013) Increased interstitial protein because of impaired lymph drainage does not induce fibrosis and inflammation in lymphedema. Arterioscler Thromb Vasc Biol 33:266–274CrossRefPubMed
14.
go back to reference Nicoli F, Chilgar RM, Sapountzis S, Lazzeri D, Sze Wei MY, Ciudad P, Nicoli M, Lim SY, Chen PY, Constantinides J, Chen HC (2014) Lymphedema fat graft: an ideal filler for facial rejuvenation. Arch Plast Surg 41:588–593CrossRefPubMedPubMedCentral Nicoli F, Chilgar RM, Sapountzis S, Lazzeri D, Sze Wei MY, Ciudad P, Nicoli M, Lim SY, Chen PY, Constantinides J, Chen HC (2014) Lymphedema fat graft: an ideal filler for facial rejuvenation. Arch Plast Surg 41:588–593CrossRefPubMedPubMedCentral
15.
go back to reference (2013) The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 46: 1-11 (2013) The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 46: 1-11
16.
go back to reference Bruns F, Micke O, Bremer M (2003) Current status of selenium and other treatments for secondary lymphedema. J Support Oncol 1:121–130PubMed Bruns F, Micke O, Bremer M (2003) Current status of selenium and other treatments for secondary lymphedema. J Support Oncol 1:121–130PubMed
17.
go back to reference Liu NF, Olszewski W (1993) The influence of local hyperthermia on lymphedema and lymphedematous skin of the human leg. Lymphology 26:28–37PubMed Liu NF, Olszewski W (1993) The influence of local hyperthermia on lymphedema and lymphedematous skin of the human leg. Lymphology 26:28–37PubMed
18.
go back to reference Hwang WT, Chung SH, Lee JS (2015) Complex decongestive physical therapy and low-level laser therapy for the treatment of pediatric congenital lymphedema: a case report. J Phys Ther Sci 27:2021–2022CrossRefPubMedPubMedCentral Hwang WT, Chung SH, Lee JS (2015) Complex decongestive physical therapy and low-level laser therapy for the treatment of pediatric congenital lymphedema: a case report. J Phys Ther Sci 27:2021–2022CrossRefPubMedPubMedCentral
19.
go back to reference Piller N, Thelander A (1998) Treating chronic post mastectomy lymphoedema with low level laser therapy: a cost effective strategy to reduce lymphoedema severity and improve the quality of patient life. Lymphology 31:74–86PubMed Piller N, Thelander A (1998) Treating chronic post mastectomy lymphoedema with low level laser therapy: a cost effective strategy to reduce lymphoedema severity and improve the quality of patient life. Lymphology 31:74–86PubMed
20.
go back to reference Wong CH, Lin LC, Lee HH, Liu CF (2012) The analgesic effect of thermal therapy after total knee arthroplasty. J Altern Complement Med 18:175–179CrossRefPubMed Wong CH, Lin LC, Lee HH, Liu CF (2012) The analgesic effect of thermal therapy after total knee arthroplasty. J Altern Complement Med 18:175–179CrossRefPubMed
21.
go back to reference Nicoli F, Constantinides J, Ciudad P, Sapountzis S, Kiranantawat K, Lazzeri D, Lim SY, Nicoli M, Chen PY, Yeo MS, Chilgar RM, Chen HC (2015) Free lymph node flap transfer and laser-assisted liposuction: a combined technique for the treatment of moderate upper limb lymphedema. Lasers Med Sci 30:1377–1385CrossRefPubMed Nicoli F, Constantinides J, Ciudad P, Sapountzis S, Kiranantawat K, Lazzeri D, Lim SY, Nicoli M, Chen PY, Yeo MS, Chilgar RM, Chen HC (2015) Free lymph node flap transfer and laser-assisted liposuction: a combined technique for the treatment of moderate upper limb lymphedema. Lasers Med Sci 30:1377–1385CrossRefPubMed
22.
go back to reference Robertson VJ, Robertson V (2006) Electrotherapy explained: principles and practice, 4th edn. Elsevier Health Sciences, Philadelphia Robertson VJ, Robertson V (2006) Electrotherapy explained: principles and practice, 4th edn. Elsevier Health Sciences, Philadelphia
23.
go back to reference Mahram M, Rajabi M (2011) Treatment of lymphedema praecox through low level laser therapy (LLLT). J Res Med Sci 16:848–851PubMedPubMedCentral Mahram M, Rajabi M (2011) Treatment of lymphedema praecox through low level laser therapy (LLLT). J Res Med Sci 16:848–851PubMedPubMedCentral
24.
go back to reference Leung TK (2015) In vitro and in vivo studies of the biological effects of bioceramic (a material of emitting high performance far-infrared ray) irradiation. Chin J Physiol 58:147–155PubMed Leung TK (2015) In vitro and in vivo studies of the biological effects of bioceramic (a material of emitting high performance far-infrared ray) irradiation. Chin J Physiol 58:147–155PubMed
25.
go back to reference Dominguez-Vidal A, Kaun N, Ayora-Cañada MJ, Lendl B (2007) Probing intermolecular interactions in water/ionic liquid mixtures by far-infrared spectroscopy. J Phys Chem B 3(111):4446–4452CrossRef Dominguez-Vidal A, Kaun N, Ayora-Cañada MJ, Lendl B (2007) Probing intermolecular interactions in water/ionic liquid mixtures by far-infrared spectroscopy. J Phys Chem B 3(111):4446–4452CrossRef
26.
go back to reference Zhou JG, Liu NF, Sl L, Wg C (2009) Effect of different materials of bandages on heat and bandage treatment for lymphedema. J Tissue Eng Reconstr Surg 5:229–230 Zhou JG, Liu NF, Sl L, Wg C (2009) Effect of different materials of bandages on heat and bandage treatment for lymphedema. J Tissue Eng Reconstr Surg 5:229–230
27.
go back to reference Li K, Liu NF, Fu LF, Wang L, Chen JJ et al (2014) Heating and bandage treatment on patients with chronic lymphedema of extremities. J Tissue Eng Reconstr Surg 10:92–95 Li K, Liu NF, Fu LF, Wang L, Chen JJ et al (2014) Heating and bandage treatment on patients with chronic lymphedema of extremities. J Tissue Eng Reconstr Surg 10:92–95
28.
go back to reference Li K, Liu N, Yu Z, Sadigh P, Lazzeri D, et al (2016) Heating and compression bandage treatment is effective for chronic lymphedema with dermatolymphangioadenitis—a case-controlled study. Lymphat Res Biol. Jun 6 Li K, Liu N, Yu Z, Sadigh P, Lazzeri D, et al (2016) Heating and compression bandage treatment is effective for chronic lymphedema with dermatolymphangioadenitis—a case-controlled study. Lymphat Res Biol. Jun 6
29.
go back to reference Harris SR, Hugi MR, Olivotto IA, Levine M (2001) Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema CMAJ 164:191–199PubMed Harris SR, Hugi MR, Olivotto IA, Levine M (2001) Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema CMAJ 164:191–199PubMed
30.
go back to reference Lee BB, Bergan JJ (2005) New clinical and laboratory staging systems to improve management of chronic lymphedema. Lymphology 38:122–129PubMed Lee BB, Bergan JJ (2005) New clinical and laboratory staging systems to improve management of chronic lymphedema. Lymphology 38:122–129PubMed
31.
go back to reference Yamamoto N, Yamamoto T, Hayashi N, Hayashi A, Iida T et al (2016) Arm volumetry versus upper extremity lymphedema index: validity of upper extremity lymphedema index for body-type corrected arm volume evaluation. Ann Plast Surg 76:697–699CrossRefPubMed Yamamoto N, Yamamoto T, Hayashi N, Hayashi A, Iida T et al (2016) Arm volumetry versus upper extremity lymphedema index: validity of upper extremity lymphedema index for body-type corrected arm volume evaluation. Ann Plast Surg 76:697–699CrossRefPubMed
32.
go back to reference Fatma Vatansever, Michael R. Hamblin (2012) Far infrared radiation (FIR): its biological effects and medical applications. Photonics Lasers Med 1; 4: 255–266 Fatma Vatansever, Michael R. Hamblin (2012) Far infrared radiation (FIR): its biological effects and medical applications. Photonics Lasers Med 1; 4: 255–266
33.
go back to reference Cao W, Zhang D, Gan J (1999) Effects of microwave baking on the immunological cells in primary lymphedema patients. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 15:357–359PubMed Cao W, Zhang D, Gan J (1999) Effects of microwave baking on the immunological cells in primary lymphedema patients. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 15:357–359PubMed
34.
go back to reference Cao W, Zhang D, Gan J (2000) Microwave effect on immunological response of chronic limb lymphedema. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 14:105–109PubMed Cao W, Zhang D, Gan J (2000) Microwave effect on immunological response of chronic limb lymphedema. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 14:105–109PubMed
35.
go back to reference Yu SY, Chiu JH, Yang SD, Hsu YC, Lui WY et al (2006) Biological effect of far-infrared therapy on increasing skin microcirculation in rats. Photodermatol Photoimmunol Photomed 22:78–86CrossRefPubMed Yu SY, Chiu JH, Yang SD, Hsu YC, Lui WY et al (2006) Biological effect of far-infrared therapy on increasing skin microcirculation in rats. Photodermatol Photoimmunol Photomed 22:78–86CrossRefPubMed
36.
go back to reference Park JH, Lee S, Cho DH, Park YM, Kang DH et al (2013) Far-infrared radiation acutely increases nitric oxide production by increasing Ca(2+) mobilization and Ca(2+)/calmodulin-dependent protein kinase II-mediated phosphorylation of endothelial nitric oxide synthase at serine 1179. Biochem Biophys Res Commun 436:601–606CrossRefPubMed Park JH, Lee S, Cho DH, Park YM, Kang DH et al (2013) Far-infrared radiation acutely increases nitric oxide production by increasing Ca(2+) mobilization and Ca(2+)/calmodulin-dependent protein kinase II-mediated phosphorylation of endothelial nitric oxide synthase at serine 1179. Biochem Biophys Res Commun 436:601–606CrossRefPubMed
37.
go back to reference Masuda A, Nakazato M, Kihara T, Minagoe S, Tei C (2005) Repeated thermal therapy diminishes appetite loss and subjective complaints in mildly depressed patients. Psychosom Med 67:643–647CrossRefPubMed Masuda A, Nakazato M, Kihara T, Minagoe S, Tei C (2005) Repeated thermal therapy diminishes appetite loss and subjective complaints in mildly depressed patients. Psychosom Med 67:643–647CrossRefPubMed
38.
go back to reference Hu KH, Li WT (2007) Clinical effects of far-infrared therapy in patients with allergic rhinitis. Conf Proc IEEE Eng Med Biol Soc 2007:1479–1482PubMed Hu KH, Li WT (2007) Clinical effects of far-infrared therapy in patients with allergic rhinitis. Conf Proc IEEE Eng Med Biol Soc 2007:1479–1482PubMed
39.
go back to reference Reichert FL, Mathes ME (1936) Experimental lymphedema of the intestinal tract and its relation to regional cicatrizing enteritis. Ann Surg 104:601–616CrossRefPubMedPubMedCentral Reichert FL, Mathes ME (1936) Experimental lymphedema of the intestinal tract and its relation to regional cicatrizing enteritis. Ann Surg 104:601–616CrossRefPubMedPubMedCentral
40.
go back to reference Pereira L, Marques R, Pantoja P, Soares CA, Travassos F et al (1966) Study of the proteins in blood and interstitial fluid of patients with lymphedema and elephantiasis. Preliminary note. Angiologia 18:31–34PubMed Pereira L, Marques R, Pantoja P, Soares CA, Travassos F et al (1966) Study of the proteins in blood and interstitial fluid of patients with lymphedema and elephantiasis. Preliminary note. Angiologia 18:31–34PubMed
41.
go back to reference Mikes DM, Cha BA, Dym CL, Baumgaertner J, Hartzog AG et al (1999) Bioelectrical impedance analysis revisited. Lymphology 32:157–165PubMed Mikes DM, Cha BA, Dym CL, Baumgaertner J, Hartzog AG et al (1999) Bioelectrical impedance analysis revisited. Lymphology 32:157–165PubMed
42.
go back to reference Suehiro K, Morikage N, Murakami M, Yamashita O, Ueda K et al (2014) Subcutaneous tissue ultrasonography in legs with dependent edema and secondary lymphedema. Ann Vasc Dis 7:21–27CrossRefPubMedPubMedCentral Suehiro K, Morikage N, Murakami M, Yamashita O, Ueda K et al (2014) Subcutaneous tissue ultrasonography in legs with dependent edema and secondary lymphedema. Ann Vasc Dis 7:21–27CrossRefPubMedPubMedCentral
43.
go back to reference Uwiera RR, Mangat R, Kelly S, Uwiera TC, Proctor SD (2016) Long-term catheterization of the intestinal lymph trunk and collection of lymph in neonatal pigs. J Vis Exp Uwiera RR, Mangat R, Kelly S, Uwiera TC, Proctor SD (2016) Long-term catheterization of the intestinal lymph trunk and collection of lymph in neonatal pigs. J Vis Exp
44.
go back to reference Pahk K, Rhee S, Kim S, Choe JG (2016) Predictive role of functional visceral fat activity assessed by preoperative F-18 FDG PET/CT for regional lymph node or distant metastasis in patients with colorectal cancer. PLoS One 11:e0148776CrossRefPubMedPubMedCentral Pahk K, Rhee S, Kim S, Choe JG (2016) Predictive role of functional visceral fat activity assessed by preoperative F-18 FDG PET/CT for regional lymph node or distant metastasis in patients with colorectal cancer. PLoS One 11:e0148776CrossRefPubMedPubMedCentral
45.
go back to reference Cuzzone DA, Weitman ES, Albano NJ, Ghanta S, Savetsky IL et al (2014) IL-6 regulates adipose deposition and homeostasis in lymphedema. Am J Physiol Heart Circ Physiol 306:H1426–H1434CrossRefPubMedPubMedCentral Cuzzone DA, Weitman ES, Albano NJ, Ghanta S, Savetsky IL et al (2014) IL-6 regulates adipose deposition and homeostasis in lymphedema. Am J Physiol Heart Circ Physiol 306:H1426–H1434CrossRefPubMedPubMedCentral
46.
go back to reference Karlsen TV, Karkkainen MJ, Alitalo K, Wiig H (2006) Transcapillary fluid balance consequences of missing initial lymphatics studied in a mouse model of primary lymphoedema. J Physiol 574:583–596CrossRefPubMedPubMedCentral Karlsen TV, Karkkainen MJ, Alitalo K, Wiig H (2006) Transcapillary fluid balance consequences of missing initial lymphatics studied in a mouse model of primary lymphoedema. J Physiol 574:583–596CrossRefPubMedPubMedCentral
Metadata
Title
Efficacy and safety of far infrared radiation in lymphedema treatment: clinical evaluation and laboratory analysis
Authors
Ke Li
Zheng Zhang
Ning Fei Liu
Shao Qing Feng
Yun Tong
Ju Fang Zhang
Joannis Constantinides
Davide Lazzeri
Luca Grassetti
Fabio Nicoli
Yi Xin Zhang
Publication date
01-04-2017
Publisher
Springer London
Published in
Lasers in Medical Science / Issue 3/2017
Print ISSN: 0268-8921
Electronic ISSN: 1435-604X
DOI
https://doi.org/10.1007/s10103-016-2135-0

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