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Proteolytic enzymes in prevention and treatment of lymphatic oedema of arm after axillary dissection or radiotherapy

M. Machánová1, M. Wald2, M. Bechyne3, J. Prausová4, J. Adámek2

1Centre of Oncology, Hospital in Liberec
2Dept. of Surgery, Univ. Hospital Motol, Prague
3Dept. of Dermatology, Univ. Hospital Bulovka, Prague
4Dept. of Oncology, Univ. Hospital, Motol, Prague - Czech Republic

17th Annual ESTRO Meeting, Edinburgh, Scotland, UK, 20-24 September 1998. 
 published in Radiotherapy & Oncology 1998, Vol. 48, No. 11, Poster 589.  

477 KA 

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PURPOSE: Lymphoedema of the arm in breast cancer pts as a side effect of curative treatment, including radiotherapy, is acc. to various authors in 7 - 30%. Proteases show pharmacological effects on almost all pathophysiological mechanisms causing lymphoedema.

METHODS: Combination of plant and animal proteases were used: papain, bromelain, trypsin, chymotrypsin together with pancreatin, lipase and rutosid. Drugs are administered orally but they act systemically. The indication was either prophylactic after breast surgery with axillary dissection or therapeutic immediately after occurrence of first signs of oedema. Combination with physical procedures, including manual massages using technique improving lymph drainage, massages using apparatuses with gradual air pressure wave and low pressure elastic bandages, was used in some cases.

RESULTS: 338 pts in 4 trials (60, 46, 144, 88) were treated and evaluated. Very good response was observed in 75%.

CONCLUSION: We consider the enzyme therapy to be a indispensable in the current complex of prophylactics and treatment of the arm lymphoedema significantly improving quality of life of these pts. The authors stress out a necessity of an early beginning of the drug administration.

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