Treatment of Lymphedema with Lasers

As part of Complex Decongestive Physiotherapy, (CDP)
or Complete Decongestive Therapy (CDT)

About Laser Therapy	FDA Approves Laser Therapy

Let There be Light

By Lynette Barnet B.H.Sc (C.M.) Dr. Vodder MLD Specialist - Australia
Ann Angel, Executive Director of Rian Corp. Pty. Ltd - Australia

I (Lynette Barnet B.H.Sc (C.M.)) am a Vodder trained therapist, working in Australia, who has been using low level laser for lymphedema since 1993.

The LTU-904 low level laser has now been introduced to the US and I would like to give you my impression of laser as a treatment for lymphedema.

Laser is a specific type of light. Normal light from the sun produces a range of wavelengths including ultraviolet light. A laser produces light of just one color or wavelength and the light waves are all in phase.

Lasers are used for a variety of medical conditions and different wavelengths are used for different applications. Yellow light lasers are used to treat birthmarks, green light lasers are used in ophthalmology. Many lasers produce invisible wavelengths.

Power is also varied to give different tissue effects. High powered lasers can cut tissue or shatter plaque.

The laser for LE treatment is a very low power laser. It does not create any heat, but it activates cell activity. It is like the sun causing photosynthesis in plants, or producing vitamin D for our bodies. This low level of light does not damage any cell components.

Low power lasers have been used in Europe for a range of conditions since the 1960’s and in Australia and Japan since the 1980’s, mainly for pain relief and wound healing.

The low power laser that I use (LTU-904) was cleared by the US Food and Drug Administration (FDA) for LE in October 2006. This particular laser is the only unit currently FDA cleared for lymphedema. Clearance was given after FDA scientists reviewed and assessed the clinical trial data. They concluded that the LTU-904 laser is safe and effective for post breast cancer lymphedema.

The LTU-904 was being used for a range of conditions in Australia and Japan for more than 15 years before a clinical trial using laser for LE was started. Many therapists had already reported positive results, but the scientific community wanted to see more rigorous clinical trials undertaken. The LTU-904 manufacturer (Riancorp Pty Ltd) and Flinders University in Australia applied for an Australian Government research grant to support the trial.

The trial was a randomised double blind study and this is considered the most rigorous type of evaluation that can be done for a medical product. In this type of trial one group is treated with a working laser and another group is treated with a non functioning laser. Neither the patients nor the therapists know which group is receiving which treatment option. Hence the term “double blind”.

The trial showed that the LTU-904 is an effective treatment for post breast cancer LE and it was this data that the FDA reviewed.
The most interesting part of the clinical trial was that patients continued to improve for three months after treatment had stopped. This is great news for patients who are looking for treatment alternatives that are less time consuming.

Lasers have been used in Australia for LE for more than 10 years. It is estimated that about 50% of Australian LE clinics now incorporate low level laser in their treatment.

It is new in the US and a few therapists are currently trying the laser and some have purchased units. Many clinics have 12-18 month lead time for purchasing of new equipment, so it will take time before laser treatment is readily available.

Patients can purchase and use the laser themselves, but a medical prescription is necessary and everyone agrees that you should work with a therapist if you want to try this option and get the best outcomes.

US Insurance is not an area that I understand, so I recommend that you talk to Mark Knight from Biohorizon Medical if you have insurance questions. mk@biohorizonmedical.com .

I (Ann Angel, Executive Director of Rian Corp. Pty. Ltd) have been using the LTU-904 laser in my clinic since 1995. I use it in conjunction with other LE treatments like manual lymphatic drainage and garments. If I was asked “why do you use the laser” my answer would be that it gives my patients a most satisfying outcome without so much hard work for the therapist or the patient. The laser is not hard to use or uncomfortable for the patient. I can release hard or fibrotic tissue with the laser without spending many minutes or even hours trying to massage fibrotic areas.

The laser is wonderful for “cording” (or axillary web syndrome), tight scar tissue, hard breast tissue and tight muscles. With my laser I can make a difference in these conditions after 1 or 2 treatments.

Laser treatment does not produce immediate limb volume reduction. The clinical trial showed that limb volume reduction started at the time of treatment (but was small). Three months after treatment had finished the limb volume reduction was significant.

I find that patients with hard or fibrotic tissue usually get more immediate results. As with every treatment, some patients respond better than others. Most of my new patients receive laser (in conjunction with MLD) three times per week for three weeks as a starting point. The laser treatment is about 15 minutes and does not add time to treatments. The laser is used before MLD or bandaging.

Not every patient can come in that often, so some patients come to me once per week or twice a week. In my experience laser therapy is not as rigid as compression therapy. With compression therapy, when you stop the compression, the LE can return. With laser, (as proven in the clinical trial) the effect lasts much longer, so the need for regimented treatments is not apparent. I can generally notice a difference in the tissue (and so can the patient) within a couple of weeks. The clinical trial showed that to get a significant volume reduction, the treatment needs to be over 6 weeks

After the initial treatment block many patients will not come back to me for 3-6 months. I advise my patients to call me when they feel that their arm is getting heavy or feeling funny and they come in for a treatment.

There are differences in LE treatment between Australia and the US, but I believe that laser use in my clinic has certainly reduced the amount of time and effort that patients and I have to spend managing lymphedema. I can't imagine treating lymphedema patients without the advantage of the laser.

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FDA Approves LTU-940 Low Level Laser for Lymphedema Treatment

By Jeanne Tassis, COHLF, President and Founder

The Circle of Hope Lymphedema Foundation is excited to announce that the FDA has approved the LTU-904 low level laser as a treatment for lymphedema. This low level laser was cleared by the US Food and Drug Administration for Lymphedema in October 2006. It is now being marketed in the United States and being used by some therapists.

I was fortunate to attend a seminar recently about this treatment. Clearance was given after the FDA scientists reviewed and assessed the clinical trial data. They concluded that the LTU-904 laser is safe and effective for post breast cancer lymphedema. Ann Angel from Rian Corp explained the clinical trials. She explained that the LTU-904 was being used for a wide range of conditions in Australia and Japan for more than 15 years before a clinical trial using laser for Lymphedema was started. The LTU-904 manufacturer (Rian corp Pty Ltd) and Flinders University in Australia applied for and received an Australian Government research grant to support the trial. The trial was a randomized double blind study and this is considered the most rigorous type of evaluation that can be done for a medical product. The trial showed that the LTU-904 is an effective treatment for post breast cancer. The most interesting part of the study was that patients continue to improve for three months after treatment had stopped.

A Vodder trained therapist was also at this seminar. Lyn Barnet is a therapist in Australia and has used the LTU-904 laser in her clinic since 1995. She uses it in conjunction with other Lymphedema treatments like Manual Lymph Drainage and garments. She explained that she can release hard fibrotic tissue with the laser without spending many minutes or even hours trying to message fibrotic areas. The Laser treatment does not produce immediate limb volume reduction. The clinical trial showed that the volume reduction started at the time of treatment but was small. Three months after treatment had finished the volume reduction was significant. Patients with hard fibrotic tissue are the ones that get more immediate results. I can attest to this since I stayed after the seminar and had a treatment with the laser. I felt no pain or discomfort but the fibrotic tissue I have from my breast cancer surgery and radiation was softened after one treatment. I could not believe the results I saw. I know I need more treatment but I have great hope that this treatment is one I will respond very well to in conjunction with my daily home lymphedema maintenance. I plan on having further treatment here in CT. in August.

My therapists in NY and Hamden are both using this laser as a trial. I will be one of the patients that will be having this treatment.
I completed treatment and found the LTU-904 Laser very helpful in reducing my fibrotic tissue. I am a 25 year breast cancer survivor and had a lumpectomy, dissection of the lymph nodes under my arm and 8 weeks of radiation therapy with 3 doses of radiation each day for 8 weeks. I also had another biopsy on the same breast 9 years ago which turned out to be fibrotic tissue. Over the last 8-9 years the fibrotic tissue has gotten worse in the breast. I have had MLD for this plus used other methods to break up the fibrotic tissue with only temporary success and relief.

I went to my therapist and had 12 sessions of the LTU-904 Laser Treatment along with some MLD and the fibrotic tissue has greatly dissipated and the pain level from the fibrotic tissue has gone from an 8-9 to a 1-2 level on a scale of 1-10. I can be hugged with no pain!!!! This treatment was a great success for me! I have spoken to others that have used the laser treatment and they had reductions in fibrosis and reduction in their lymphedema in their arms and hands. There was also reduction in scar tissue which increased their overall reduction in their volume of lymphedema and size of the limb.

There was no pain involved with the treatment and no negative side effects. I will be following up with my therapist and watching things closely. Since this was able to help with the Lymphedema and Fibrosis in my breast it is a great asset in reducing the fibrotic tissue in the arm and hand as well. When the fibrotic tissue is reduced the therapist is able to move the lymphatic fluid easier and faster. Because of the quicker break up of the fibrotic tissue the therapist is able to get better reduction in the volume of lymphedema and swelling. This treatment is used in conjunction with CDT-MLD. Since in the clinical trials it stated that the lymphedema continued to improve for 3 months after the treatment, it will be interesting to get the results of the treatment checked in 3 months. It is another tool to help lymphedema patients which is great news!

The Circle of Hope Lymphedema Foundation will continue to follow this new treatment. I will personally let others know what my thoughts and opinions are about this new laser treatment as the months continue. We will have an article written in our next Circle of Hope Lymphedema Foundation Newsletter. We are also looking forward to having a seminar in Waterbury at the Harold Leever Regional Cancer Center in March. Ann Angel from Rian Corp will be speaking about the LTU-904 Low-Level Laser Treatment. This seminar will be open to all medical professionals and patients.

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