Current status of selenium and other treatments for secondary lymphedema.

The unsatisfactory status of lymphedema treatment in patients with cancer warrants an intensified search for new treatment approaches, especially since survival of cancer patients has improved markedly. Lymphedema, regardless of etiology, is essentially incurable, but current therapeutic approaches can reduce swelling, restore shape, and prevent inflammatory episodes. The most conservative approach is physical therapy, including a combination of compression, exercise, and, if possible, massage.Meticulous skin care is needed to avoid recurrent inflammatory episodes. If physical therapy fails, surgery, in the form of reducing or "debulking" operations, is indicated, while microsurgical interventions for certain forms of lymphedema continue to be evaluated. Drug therapy has included the use of diuretics, corticosteroids, and coumarin- or flavonoid-type compounds. Diuretics and corticosteroids may be useful in edema of mixed origin and in palliative circumstances but cannot be recommended for persistent lymphedemas. Coumarin and flavonoids reduce swelling in all types of lymphedema, but their long-term use is problematic. One promising step in drug therapy seems to be the introduction of free-radical scavengers, such as selenium. Present data demonstrate that selenium can enhance the benefits of physical therapy in radiation-induced lymphedemas. The very low toxicity profile of selenium and its cost effectiveness are further arguments for its use in lymphedema treatment.