Prognostic factors for lymphedema in patients with locally advanced head and neck cancer after combined radio(chemo)therapy- results of a longitudinal study

Tribius, Silke; Pazdyka, Henning; Tennstedt, Pierre; Busch, Chia‐Jung; Hanken, Henning; Krüll, Andreas; Petersen, Cordula

doi:10.1016/j.oraloncology.2020.104856

Cited by 18 publications

(20 citation statements)

References 51 publications

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Section: Resultsmentioning

confidence: 99%

“…For the purposes of diagnosis, classification and monitoring of external HNL, rating scales do represent an improvement on the ad hoc grading of lymphedema applied in many papers. 6,30,[44][45][46][47] The clinician is required to take into account several standardized features, rather than simply a general impression, in determining the presence and severity of HNL. The other clear benefit is their ease of use, obviating the time and costs involved in physical measurements or formal imaging, and suitable to be applied by a range of trained providers, including doctors, speech-language pathologists, physiotherapists and occupational therapists.…”

Section: Clinician-reported Assessment Methods: Rating Scalesmentioning

confidence: 99%

“…[1][2][3][4][5][6] Both neck dissection and radiotherapy have been implicated in the development of secondary HNL, with the use of multiple treatment modalities conferring a particularly increased risk. [6][7][8][9][10] HNL is thought to occur due to treatment-related injury to the head and neck lymphatics, resulting in a disruption of normal lymphatic drainage and an accumulation of lymph fluid in the interstitial space. 11,12 Two subtypes have been distinguished: external HNL, present in the face, submental region and neck; and internal HNL, affecting structures of the oral cavity, pharynx and larynx.…”

Section: Introductionmentioning

confidence: 99%

“…The reported prevalence of secondary HNL in patients treated for HNC varies greatly due to methodological differences between studies, with estimates ranging from 12% to as high as 90%. [1][2][3][4][5][6] Both neck dissection and radiotherapy have been implicated in the development of secondary HNL, with the use of multiple treatment modalities conferring a particularly increased risk. [6][7][8][9][10] HNL is thought to occur due to treatment-related injury to the head and neck lymphatics, resulting in a disruption of normal lymphatic drainage and an accumulation of lymph fluid in the interstitial space.…”

Section: Introductionmentioning

confidence: 99%

“…Head and neck lymphedema (HNL) is an increasingly recognized complication of head and neck cancer (HNC) and its treatment. The reported prevalence of secondary HNL in patients treated for HNC varies greatly due to methodological differences between studies, with estimates ranging from 12% to as high as 90% 1–6 . Both neck dissection and radiotherapy have been implicated in the development of secondary HNL, with the use of multiple treatment modalities conferring a particularly increased risk 6–10 .…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of head and neck lymphedema assessment

et al. 2022

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Head and neck lymphedema (HNL) is an increasingly recognized complication of head and neck cancer and its treatment. However, no consensus exists on the "gold-standard" assessment tool for the purposes of diagnosis, classification, or monitoring of HNL. We conducted a systematic review of the literature regarding HNL assessment to determine the optimal method/s of assessment for patients with HNL. A review of publications between January 2000 and September 2021 was undertaken on four electronic databases. Studies were excluded if no clear assessment method of HNL was documented. Sixty-seven articles were included in the study. A wide range of assessment methods for HNL have been reported in the literature. For the purposes of diagnosis and classification of physical findings, computed tomography (CT) appears the most promising tool available for both external and internal HNL. In terms of monitoring, ultrasound appears optimal for external HNL, while a clinicianreported rating scale on laryngoscopy is the gold standard for internal HNL.

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Section: Resultsmentioning

confidence: 99%

Section: Clinician-reported Assessment Methods: Rating Scalesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Systematic review of head and neck lymphedema assessment

et al. 2022

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Prognostic Factors and Outcomes Associated With Neck Lymphedema in Head and Neck Cancer Survivors

Lao,

Berry,

et al. 2024

The Laryngoscope

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ObjectivesThe purpose of this study is to determine the predictors of neck lymphedema and to explore its association with symptoms and patient‐reported outcomes (PROs) in Head and Neck Cancer (HNC) patients who underwent non‐operative treatment.MethodsThis study involved a cross‐sectional secondary analysis of data from patients diagnosed with head and neck squamous cell carcinoma who underwent radiation therapy (±chemotherapy). Patients with visits <6 weeks or >2 years following completion of radiation and those with recurrent or metastatic cancer were excluded. Presence of post‐treatment lymphedema, demographics, clinical characteristics, health‐related behaviors, and symptoms were collected. PROs were obtained using validated questionnaires that assessed depression, anxiety, swallowing dysfunction, and quality of life (QOL). Multivariable regression models were used to examine the relationship between lymphedema with predictors and symptoms.ResultsOf the 203 patients included, 88 (43.4%) developed post‐treatment lymphedema. In multivariable analysis, pre‐treatment Body Mass Index (BMI) (odds ratio [OR] = 1.07, 95% confidence interval [CI] [1.01, 1.14] p = 0.016) and N stage (OR = 1.96, 95% CI [1.06, 3.66], p = 0.032) were found to be independently associated with lymphedema. Regarding PROs, lymphedema was associated with greater swallowing dysfunction (3.48, 95% CI [0.20, 6.75], p = 0.038), decreased mouth opening (−3.70, 95% CI [−7.31, −0.10], p = 0.044), and increased fatigue (1.88, 95% CI [1.05, 3.38], p = 0.034).ConclusionHigher pre‐treatment BMI and greater N stage are identified as independent predictors for lymphedema development in non‐operative HNC patients. Additionally, patients experiencing lymphedema reported worsening swallowing dysfunction and increased symptoms related to trismus and fatigue. Recognizing patients at elevated risk for lymphedema allows for early intervention, alleviation of symptom burden, and optimization of health care resources.Level of Evidence4 Laryngoscope, 2024

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Lymphedema Prospective Surveillance and Risk Reduction

Stout

Armer

2022

Multimodal Management of Upper and Lower Extremity Lymphedema

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Prognostic factors for lymphedema in patients with locally advanced head and neck cancer after combined radio(chemo)therapy- results of a longitudinal study

Cited by 18 publications

References 51 publications

Systematic review of head and neck lymphedema assessment

Systematic review of head and neck lymphedema assessment

Prognostic Factors and Outcomes Associated With Neck Lymphedema in Head and Neck Cancer Survivors

Lymphedema Prospective Surveillance and Risk Reduction

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