Secondary
lymphedema (LE) in the proximal extremities develop with relatively high frequency in
cancer patients after
tumor resection, lymph-node obliteration, and/or postoperative irradiation.
Physical therapy combined with manual or mechanical lymph drainage and compression bandaging provides symptomatic relief but does prevent the progression of degenerative changes in the affected tissues. As biochemical studies have linked these changes significantly to the excessive generation of
oxygen radicals in the affected tissues, LE
therapy should aim to eliminate
oxygen radical production. Because
selenium is a functional component of
antioxidant enzymes, has anti-inflammatory properties, and reduces the expression of endothelial cell adhesion molecules, its effect was investigated in postmastectomy patients with LE of the arm.
Sodium selenite administered orally in isotonic
solution (selenase) at oral dosages of 800 microg Se/day on days 1 through 4 and 500 microg Se/day on days 5 through 28 produced a spontaneous reduction in LE volume and normalized blood parameters in a manner consistent with diminished
oxygen radical production. In a randomized, placebo-controlled, double-blind study with postmastectomy LE patients undergoing combined physical decongestion
therapy (
CPDT),
selenite at similar dosages increased the efficacy of
CPDT and improved the mobility and heat tolerance of the affected extremity. The patients in this study received 1000 microg of Se/day orally during the first week, 300 microg Se/day during the second and third weeks, and a maintenance dose of 100 microg Se/day during 3 months of follow-up. All patients remained
erysipelas-free during the 3 weeks of
CPDT and the 3-month follow-up period. Based on the available evidence, supplementation with
sodium selenite in isotonic
solution is judged to be a valuable and safe extension of the physical decongestive
therapy of LE.