A Prospective Study of the Lymphedema and Fibrosis Continuum in Patients with Head and Neck Cancer

Abstract

Background: The purpose of this study was to determine the prevalence and nature of internal, external, and combined lymphedema and fibrosis in patients with head and neck cancer (HNC). Materials and Methods: We obtained consent from 100 patients newly diagnosed with having cancer of the head and neck for a 4-year, prospective, longitudinal descriptive study. Recruitment began in August 23, 2010, and the study was completed in April 24, 2014. Eighty-three were evaluated at regular intervals from preradiation therapy to 18 months post-treatment. Percentage developing external, internal, or both types of lymphedema and/or fibrosis and trajectories of the severity of external, internal, or both types of lymphedema and/or fibrosis were determined. Results: Before treatment, lymphedema rates were the following: external: 62.7%, internal: 41.7%, or combined: 29.2%, and/or fibrosis: 42.2%. Ranges of lymphedema late-effect rates were even higher: external: 81.9%-90.1%, internal: 80.4%-89.4%, combined: 70.6%-80.9%, and fibrosis: 66.7%-77.4%. Approximately 75% had a late-effect trajectory characterized by moderate to severe external or internal lymphedema; *47% had moderate to severe fibrosis. Conclusion: Lymphatic and soft tissue complications of HNC occur not only post-treatment but also before treatment. They are ubiquitous throughout the first 18 months post-treatment, with greater than 90% of patients in our study experiencing some form of internal, external, or combined lymphedema, and over half of those patients developing fibrosis. Further research regarding these conditions is indicated.

Treatment of late sequelae after radiotherapy for head and neck cancer

“…Likewise, the prognostic relevance of acute radiation-induced symptoms for the development of late dysphagia underscores the etiologic role of inflammation [11]. Edema is currently under study in a prospective cohort as another acute sequela along the continuum to soft tissue fibrosis, suggesting the potential adjunctive role of lymphedema therapy strategies for dysphagia management [92]. The etiologic role of inflammation and edema may be more relevant for classic forms of persistent dysphagia as a consequential late effect of acute reactions.…”

Depressive symptoms, social anxiety, and perceived neck function in patients with head and neck cancer

“…In particular, morbidity may persist for months or years after the completion of treatment, impairing survivors' ability to complete activities of daily living and decreasing their quality of life . Lymphedema and fibrosis are ubiquitous in this population and are associated with significant functional deficits . For example, individuals who are not able to drive a car due to limited neck mobility may become socially isolated from precancer social networks.…”

Lymphedema after combination treatment of head and neck tumors

“…Частота развития той или иной степени отека варьи-рует от 12,1 [3] до 90 % [4]. По данным J. Deng и соавт., в 2012 г. в США более 500 тыс.…”