Omar, M.T., Shaheen, A.A., & Zafar, H. (2012). A systematic review of the effect of low-level laser therapy in the management of breast cancer-related lymphedema. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 20(11), 2977–2984.

To review the effect of low-level laser therapy (LLLT) in the management of breast cancer-related lymphedema

Databases searched were MEDLINE, EMBASE, CINAHL, Center for Reviews and Dissemination, PEDro, and Cochrane Database of Systematic Reviews. Search keywords were breast cancer, lymphedema, and low level laser therapy. Studies were included in the review if they

• Were randomized controlled and uncontrolled trials. 
• Had a sample of women with unilateral lymphedema secondary to breast cancer surgery
• Had a sample that experienced a limb volume increase greater than or equal to 100 ml compared to the contralateral limb. 
• Compared LLLT  to no treatment, placebo, or another therapy.

The total references retrieved was 10. Literature was evaluated using Sackett''s levels of evidence. The PEDro Scale was used to rate the methodological quality of trials.

• The final number of studies included was eight. 
• The total sample across studies was 210 patients, with a range of 10–64.

The study has clinical applicability for late effects and survivorship.

A variety of doses and laser wavelengths were studied with different definitions for lymphedema.  3b dual wavelength scanning was used in three studies with favorable results. Hand-held 3b lasers were used in five studies where the laser was applied directly over fibrotic or congested areas. All doses were within the therapeutic window. In most studies, treatment was three times weekly with up to 18 total sessions over three to four months. Various methods were used to measure outcomes and reliability of measures was not discussed. Sometimes laser was used in combination with other co-interventions that could have influenced results.

There is moderate to strong evidence for effectiveness of LLLT for the management of breast cancer-related lymphedema.

• The review had a limited number of studies. 
• The variation of methods of outcome measurement and variability of LLLT treatment regimens makes comparison across studies difficult. 
• Co-interventions used in studies could intervene to affect results. 
• There were substantial baseline differences in study sample groups (the duration and severity of lymphedema varied greatly).

Findings suggest moderate to strong support for use of LLLT to manage lymphedema among patients with breast cancer. Research in this area needs to incorporate reliability of lymphedema measurement and common definitions of lymphedema