Table 1_Effectiveness of physical therapy for lower limb lymphedema in gynecological cancer survivors: a systematic review of randomized controlled trials.docx

ObjectiveSecondary lower limb lymphedema (LLL) is a long-term side effect following surgery or radiotherapy in survivors with gynecological cancer. This systematic review aims to systematically evaluate the effectiveness of physical therapy interventions for LLL patients with gynecological cancer, providing evidence-based support for clinical practice.
MethodsWe searched the Medline, Web of Science, Scopus, and Cochrane Library databases for literature published up to 27 December 2025. We include randomized controlled trials (RCTs) focusing on physical therapy as the main interventions for LLL in gynecological cancer survivors. Literature screening and data extraction were performed using the Rayyan platform, and the methodological quality of included studies was assessed with the Cochrane Risk of Bias 2 (ROB 2) tool. This systematic review has been registered in PROSPERO (Registration number: CRD420251274284).
ResultsSix RCTs involving a total of 289 eligible patients were ultimately included. None of the included RCTs were judged to have a high risk of bias. Results showed that physical therapy interventions resulted in significant reductions in lower limb volume or circumference across studies. Additionally, they alleviated symptoms such as pain and heaviness, and improved physical functions including muscle strength and gait, as well as quality of life. Evidence indicates that the multimodal physical therapy strategy showed a superior trend in improving the most outcomes compared to a single therapy mode. All intervention-related adverse events were mild, with no serious adverse events reported.
ConclusionOverall, this systematic review confirms that both multimodal and single physical therapy are safe and effective for secondary lower limb lymphedema in gynecologic cancer survivors. A combination of different physical therapy modalities may be a better option. The results of this study may provide an evidence-based reference for clinical decision-making about LLL intervention strategies in this specific population.
Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251274284, identifier CRD420251274284.