COMPARATIVE STUDY OF THE CLINICAL EFFICACY OF TWO DIFFERENT COUMARIN DOSAGES IN THE MANAGEMENT OF ARM LYMPHEDEMA AFTER TREATMENT FOR BREAST CANCER

In a randomized, double-blind, parallel group study, we compared the clinical efficacy ofcoumarin 90 mg/day (Group A) with 135 mg/day (Group B) in 77 women (age 35-65 years) withlymphedema of the upper limb secondary to surgery and irradiation for treatment of breastcancer. During 12 months of coumarin therapy, the arm volume of lymphedema and a clinicalscore (degree of arm edema, heaviness, hardness, and neuralgia/dysesthesia) were determined.In both groups, the volume of arm lymphedema decreased (14.9% in Group A and 13.2% inGroup B) (N.S.), the overall clinical score improved (12.9 ± 4.3 to 5.7 ± 3.5 in Group A andfrom 11.7 ± 3.7 to 4.7 ± 3.9 in Group B) (N.S.), and the overall efficacy of coumarin wassimilarly good or excellent (71.9% in Group A and 68.6% in Group B) (N.S.). Only mild tomoderate side effects of drug therapy were recorded.Coumarin prevents a spontaneous trend toward an increase in arm lymphedema aftertreatment of breast cancer, decreases the severity of local symptoms, and overall improves thequality of life. No difference was found between the apparent benefits of coumarin at 90 mg/daycompared with 135 mg/day.