Lymfoedeem bij borstkanker: Venoruton vermindert in gerandomiseerd-dubbelblind onderzoek lymfoedeem samenhangend met een borstamputatie.

8 september 2018: lees ook dit artikel:

https://kanker-actueel.nl/lymfoedeem-ontstaan-direct-na-een-operatie-van-okselklieren-na-bestraling-van-de-oksel-ontstaat-lymfoedeem-vaak-enkele-jaren-later.html

27 juni 2012: op de website van Fysioalign staat naar mijn mening uitstekende informatie hoe lymfoedeem is te behandelen. Voor alle duidelijkheid wij hebben geen enkele band met deze website en ik ken hun ook niet, maar bij zoeken via google kwam ik hierop en dit is naar mijn mening uitstekende informatie. Of de fysiotherapeutische aanpak bij deze mensen ook goed is weet ik echt niet. De website maakt wel een goede professionele indruk.

Op de website van stichting Olijf staat ook goede informatie over lymfoedeem.

Op de website van borstkanker.net staat ook uitstekende informatie over lymfoedeem en hoe dat te behandelen.

Een reviewstudie van het Cochrane Instituut laat zien dat naar Venoruton en andere zogeheten Benzo-pyrones bij lymfoedeem te weinig goed gedocumenteerd onderzoek is gedaan. Hoewel onderstaande studies wel een signifcant voordeel laten zien. En ook de resultaten van de reviewstudie maken melding van therapeutische effecten tegenover placebo:

MAIN RESULTS:

Overall, 15 trials were included that evaluated the role of benzo-pyrones. Three trials of oxerutin were found. Each tested the drug over 6 months using the same dose of drug against placebo. Two were crossover trials and one a parallel group trial with a total number of 127 participants and data available for only 81 of them. There were insufficient data provided in any of the trials to calculate the per cent reduction or increase in baseline excess limb volume. Standard deviations or confidence intervals and the numbers in the groups at the different stages of the trial were missing for all the data in two of the reports and for much of the data in the third, making any attempt at meta-analysis impossible. One trial testing Cyclo 3 Fort (approved name) over 3 months was found and involved 57 patients but provided insufficient data to allow a proper analysis of its findings. A single trial of Daflon (approved name) was found, lasting 6 months and involving 104 participants; once again there was insufficient information provided in the report to reach a conclusion about the effectiveness of the drug. Three trials of coumarin combined with troxerutin were found and tested two different doses of the drug against each other with no placebo, however, numbers of participants in the trial groups and baseline data were not provided. Eight trials of coumarin were identified. Two of the reports were confirmed as reporting the same trial and a further trial potentially also referred to the same trial but this was unconfirmed. A further two papers appeared to refer to the same trial but this was not confirmed. Three trials involved the same researcher. Five studies were conducted in India or China and they added anti-filarial dia or China and they added anti-filarial drugs to the interventions tested. The numbers of participants withdrawn and the numbers included in the analyses in all these trials were not extractable; the reporting of outcome measures in most of the trials was not clear. Loprinzi's 1999 trial in the USA reported the conduct of the trial and its findings with more detail, however, its conclusions were very much at odds with the findings of the other trials, finding that no difference was observed between those on the active preparation (coumarin) and placebo in any of the outcomes under investigation. This trial also reported a case of hepato-toxicity in a patient receiving the active preparation.

REVIEWERS' CONCLUSIONS:

Meta-analysis was not performed due to the poor quality of the trials. It is not possible to draw conclusions about the effectiveness of Benzopyrones in reducing limb volume, pain, or discomfort in lymphoedematous limbs from these trials.

13 juli 2006: Bron: Piller NB et al ; Br J Plast Surg 41:20-7; 1988: met dank aan Frank

Venoruton vermindert in gerandomiseerd-dubbelblind onderzoek lymfoedeem samenhangend met een borstamputatie. Hier de door Frank vertaalde resultaten uit deze studie

RESULTATEN: Een gerandomiseerd-dubbelblind onderzoek werd uitgevoerd onder 26 patienten met postoperatieve lymfoedeem aan de armen, en 14 met lymfoedeem aan de benen. Gedurende 6 maanden namen patienten O (beta-hydroxyethyl)-rutosides (oxerutin;"Paroven", "Venoruton", Zyma) in doses van 3 g/dag, of placebos; dan namen zij het omgekeerde. Metingen (volume, omtrek, spanning-meting en huidtemperatuur) werden maandelijks gemaakt. Het actieve medicijn verminderde de volumes van de ledematen (P minder dan 0,05 tot 0.01) en hun omtrek (P minder dan 0,05 tot 0.001). Het verhoogde de zachtheid van de ledematen, zoals die door de verhogingen van de spanningsmetingswaarden wordt getoond (P minder dan 0,01 tot 0.001). Er was vermindering van de verhoogde huidtemperaturen (P minder dan 0,05 tot 0.001). Patiënten meldden verhoogd comfort en vrijheid van beweging, vermindering van hun ernstige pijnen, minder heftigheid en spanning (P minder dan 0,05 tot 0.01), en een verhoogde mobiliteit van hun ledematen (P minder dan 0.0001). De meeste patiënten (70%) verkozen het actieve dmedicijn (P minder dam 0.0001). Verhoging van het algemeen welzijn werd gerapporteerd door 97% van de patiënten bij het nemen van het actieve medicijn vergeleken met 4% voor placebo (p minder dan 0.0001).

REVIEW Lymphoedema following surgery for breast cancer

S. J. Pain and A. D. Purushotham

A double-blind, cross-over trial of O-(beta-hydroxyethyl)-rutosides (benzo-pyrones) in the treatment of lymphoedema of the arms and legs.

Piller NB, Morgan RG, Casley-Smith JR.

Department of Surgery, Flinder's Medical Centre, Bedford Park, South Australia.

Br J Plast Surg. 1988 Jan;41(1):20-7.

A randomised, double-blind, cross-over trial was performed on 26 patients with postmastectomy lymphoedema of the arm, and 14 with lymphoedema of the leg. For 6 months, patients took 0-(beta-hydroxyethyl)-rutosides (oxerutin; "Paroven", "Venoruton", Zyma) in doses of 3 g/day, or the placebos; then they took the reverse. Measurements (volume, circumferences, tonometry and skin temperature) were made monthly. The active drug reduced the volumes of the limbs (p less than 0.05 to 0.01) and their circumferences (p less than 0.05 to 0.001). It increased the softness of the limbs, as shown by the increases in the tonometry values (p less than 0.01 to 0.001). There was a lowering of the elevated skin temperatures (p less than 0.05 to 0.001). Patients reported increased comfort and freedom of movement, a lessening of their bursting pains, heaviness and tension (p less than 0.05 to 0.01), and an increased mobility of their limbs (p less than 0.0001). Most patients (70%) preferred the active drug (p less than 0.0001). An increase in general well-being was reported by 97% of patients when taking the active drug compared with 4% for placebo (p less than 0.0001).

PMID: 3278764 [PubMed - indexed for MEDLINE]