eNews Online - May 2006 Edition

eNews Online
May 2006 Edition

This Lymphedema eNews is being generated through your request from our website.

Sentinel node biopsy: Is axillary dissection required even if the lymph nodes are positive?

In previous eNews editions I have discussed the value of sentinel node biopsy in the assessment of spread of breast cancer. In these reviews, I discussed the fact that sentinel node biopsy could replace axillary dissection as a method to determine the extent of cancer involvement at the time of diagnosis. Among patients without evidence of cancer in the nodes, axillary dissection could be avoided. By avoiding axillary dissection, many women could reduce the risk of lymphedema.

In this edition of eNews, I would like to discuss new findings on the optimal management of patients who are found to have cancer in the lymph nodes at the time of sentinel node biopsy. The current standard of treatment for patients with positive nodes on sentinel node biopsy is to undergo complete surgical dissection of the axillary nodes. Axillary dissection is indicated because it reduces the chance that breast cancer will recur. However, the complications of the surgery are significant. About 20% of wo men who undergo axillary dissection develop lymphedema, 10% have chronic pain and 10% have limitations in the range of motion of their arms on the side treated with surgery.

Dr. Michele Gadd MD at Harvard Medical School evaluated the benefit of giving chemotherapy along with radiation to the involved axilla to patients with positive lymph nodes following sentinel node biopsy. The data from this study was presented at the recent San Antonio Breast Cancer Symposium. A total of 560 women with early stage breast cancer were studied. Among this group, women with evidence of lymph node involvement received radiation to the axillary region. Of the 560 women studied, 117 had positive sentinel node biopsies and 77 were evaluated for the relative benefit of radiation and chemotherapy for treatment of positive sentinel nodes. These patients were enrolled in this study starting in January of 2000 and enrollment into the study was completed in February of 2004. At the time of analysis of the data, some women were on the study for about 5 years while other were on for less than 1 year. The average time on the study was about 3 years. Among these patients, only 1 of 77 patients studied had a recurrence of cancer in the axilla. This person then underwent axillary dissection and was out about 2 years from the axillary dissection without evidence of metastatic disease. Three additional patients developed metastatic disease with evidence of cancer elsewhere in their body.

This study indicates that even among patients with positive sentinel node biopsies, treatment with chemotherapy and radiation may provide good control of the cancer in the axillary region without the need for surgery. The authors of this study stressed that additional studies are needed to clearly demonstrate that effective control of cancer in the lymph nodes is achieved with radiation instead of surgery. Furthermore, larger studies will be needed to determine the risk of lymphedema among these patients r eceiving only chemotherapy and radiation compared to those receiving axillary dissection. However, the results of this study are very promising and many women even with positive nodes after sentinel node biopsy may be candidates for radiation therapy rather than surgery.

Tony Reid MD Ph.D

The OptiFlow® RM Lower Extremity

The long anticipated release of the OptiFlow RM for the lower extremity is now available.

The OptiFlow RM brings the ReidSleeve tissue gradient technology to patients in Ready Made (RM) standard sizing. The OptiFlow RM is a less expensive and effective addition to the treatment options available to the lymphedema patient. The OptiFlow RM utilizes the Tissue Gradient Technology® (U.S. Patent 5,916,183) that has proven so effective in the ReidSleeve®Classic.

The ReidSleeve Classic has helped thousands of patients overcome lymphedema. The ReidSleeve Classic is a custom made garment used at night, replacing bandaging. Peninsula Medical is now offering standard sizing in the OptiFlow RM. Standard sizing eliminates the lengthy lead times often associated with custom garments. Additionally, the cost is significantly lower with standard sizes and makes the OptiFlowRM more affordable for patients with limited or no insurance coverage.

The lower extremity unit is from the ankle to groin (or ankle to knee in the half length style). This allows patients to have daytime non-elastic compression while utilizing a compression sock and shoe. At night patients will wrap their foot if they need compression while sleeping. We are currently working on a separate foot piece that should be available in the near future.


Patients have reported increased comfort and more consistent compression, while gaining the proven advantages of the high and low pressure points of the Tissue Gradient Technology. This patented design provides variable tissue pressure, while maximizing compression, softening tissue, and minimizing the obstruction of normal lymphatic and venous flow.

Bandages and wraps can be very useful, but do have some limitations. First, bandages and wraps are often difficult to apply properly and consistently. Second, the pressure applied may encircle, constrict, and/or obstruct normal lymphatic and venous flow. The OptiFlow RM helps overcome to these problems. This unique system provides effective and comfortable compression therapy for lymphedema patients.

Coolor and Lighter Weight

The OptiFlow RM is a lightweight, cooler and slimmer garment than the ReidSleeve Classic. It is an ideal option for patients with mild to moderate lymphedema.

The OptiFlow RM is also an effective complement to Complex Decongestive Therapy (CDT). The OptiFlow RM can help the patient effectively maintain their edema reduction achieved through CDT.

  • Lightweight and cooler
  • Eliminates bandages
  • Standard sizing - enables immediate shipping
  • Patients more compliant with night time compression
  • Designed for treatment of mild to moderate lymphedema
  • Less expensive for those without insurance coverage
  • Controls lymphedema effectively reduced with the ReidSleeve Classic or other treatments such as CDT and therapeutic massage
  • Quality materials and manufacturing from the makers of the original ReidSleeve® Classic
  • Developed by a Physician
For more information on this product or any of our products and/or a referral to the nearest authorized distributor, call us toll free 1-800-292-3362 (831-430-9066 for out of country calls) or email us using our online form located here.

ReidSleeve® Classic Approved for Ontario, Canada

We are extremely happy to announce that the Adaptive Device Program (ADP) in Ontario, Canada has now approved the ReidSleeve Classic (upper and lower extremity). Patients who are covered under ADP (in Ontario) can now go to an authorized distributor and have this product covered if they meet the eligibility criteria.

Eligibility criteria for funding of the ReidSleeve Classic; Applicants must have a diagnosis of primary or secondary lymphedema and require the use of the ReidSleeve for longer than six (6) months of regular daily/nightly use. It must be determined that the patient can not maintain/control their condition with bandaging. Contributing factors to patient's inability to maintain their condition with bandages may include; a high density edema, multiple skin folds, complicated shape of extremity and inability t o apply bandages.

We applaud ADP for recognizing the need to cover this product for lymphedema. There were many people that worked hard to get this through, an effort well done!

If you are an ADP recipient, contact your eligibility worker to attain further information about your benefits and where the nearest authorized distributor is located. Hopefully this will open the door to other areas of Canada for lymphedema patients in need.