Cebicci MA1, Sutbeyaz ST2, Goksu SS3, Hocaoglu S2, Oguz A3, Atilabey A2.Author information1
Department of Physical Therapy and Rehabilitation, Kayseri Training and Research Hospital, Kayseri, Turkey. Electronic address: maykaccebicci@gmail.com.
2
Department of Physical Therapy and Rehabilitation, Kayseri Training and Research Hospital, Kayseri, Turkey.
3
Department of Medical Oncology, Kayseri Training and Research Hospital, Kayseri, Turkey.AbstractOBJECTIVE:
To investigate the clinical effect of extracorporeal shock wave therapy (ESWT) in patients with secondary lymphedema after breast cancer treatment.
DESIGN:
Prospective clinical pilot study.
SETTING:
Education and research hospital.
PARTICIPANTS:
Women with a diagnosis of lymphedema secondary to breast cancer (N=11).
INTERVENTIONS:
Patients were treated for 12 sessions of ESWT with 2500 impulses each. The treatment frequency was 4Hz in multiple shock mode. The energy flow density during treatment was equal to a working pressure of 2 bar.
MAIN OUTCOME MEASURES:
The primary outcome measure was volumetric measurements. The secondary outcome measures were the short version of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH) and the brief version of the World Health Organization Quality of Life (WHOQOL-BREF). Assessments were conducted by the same investigator at baseline, posttreatment, and at 1, 3, and 6 months after treatment for all patients.
RESULTS:
Significant reduction was found in the amount of lymphedema with ESWT treatment in all patients, and this reduction was maintained for 6 months. A statistically significant reduction was observed in volumetric measurements for the follow-up period (P=.001). The mean volume displacement of the affected upper extremity before treatment was 870.45±384.19mL at 6 months, and after the treatment it was 604.54±381.74mL. In addition, improvements were observed in the QuickDASH functional assessment tool and in the physical health domain of the WHOQOL-BREF questionnaire (P=.002 and P=.007, respectively).
CONCLUSIONS:
ESWT was shown to provide a reduction in the amount of lymphedema in patients with lymphedema secondary to breast cancer. Also, a marked improvement was observed in the functional status and quality of life of study patients. Treatment efficacy was maintained in the long term. As a noninvasive, novel, and effective method, ESWT is a promising treatment modality for the treatment of lymphedema, which is a chronic, progressive, and refractory condition.
Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

TRT affiliate has patented this indication in the USA and will soon initiate studies.
CEApproval:https://www.storzmedical.com/en/news-press/entry/neurolith-ce-approval-transcranial-pulse-stimulation-tps-treatment-alzheimer-disease.html  
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STORZ MEDICAL’s NEUROLITH® receives CE approval – Transcranial Pulse Stimulation (TPS) on the central nervous system of patients with Alzheimer’s disease - Lithotripsy Database / Blog
In December 2018, STORZ MEDICAL has received the CE approval for the NEUROLITH ®, a new therapy system for the treatment of neurological diseases.. The technology behind the NEUROLITH ® is called Transcranial Pulse Stimulation (TPS). TPS consists of short acoustic pulses with an ultrasound frequency range that permits a well-focused stimulation of the brain at a depth of up to 5 cm.​