Weight reduction ranked highest for limb volume, while VR-based training ranked highest for pain in breast cancer-related lymphedema

Approximately 30% of breast cancer patients develop lymphedema after axillary surgery or radiotherapy, which impairs their quality of life and exacerbates symptoms. Non-pharmacological therapies show efficacy for breast cancer-related lymphedema (BCRL), but the optimal approach remains unclear. This study aimed to determine the most effective non-pharmacological interventions for BCRL by comparing limb volume, circumference, and pain outcomes. Cochrane, Embase, PubMed, and Web of Science databases were searched from inception to August 12, 2025, with key terms on BCRL, breast cancer, lymphedema, and non-pharmacological therapies. Cochrane RoB2 was used to assess the risk of bias. Network meta-analyses were conducted using R 4.4.1. SUCRA values were calculated to rank interventions. Seventeen studies (754 patients) were included. In terms of reducing limb volume, weight reduction ranked highest (SMD: -1.2, 95% CrI [-2.1, -0.22]; SUCRA = 82.21%), followed by virtual reality (VR), exercise combined with compression therapy, and exercise therapy. For pain relief, VR-based training ranked highest (SMD: -3.7, 95% CrI [-4.5, -3.0]; SUCRA = 99.65%). However, given the sparse network topology and the limited number of included studies, these rankings should be interpreted with caution. Regarding limb circumference, the currently available evidence (which included only 3 studies with limited statistical power) did not detect any statistically significant differences among the interventions. Among non-pharmacological treatments for BCRL, weight reduction was most effective in improving limb volume, while VR-based training was most effective in improving pain scores in the edematous limb. https://www.crd.york.ac.uk/prospero/, identifier CRD420250654557.