The risk of lymphedema after postoperative radiation therapy in endometrial cancer

Abstract

ObjectiveLower extremity lymphedema adversely affects quality of life by causing discomfort, impaired mobility and increased risk of infection. The goal of this study is to investigate factors that influence the likelihood of lymphedema in patients with endometrial cancer who undergo adjuvant radiation with or without chemotherapy.MethodsA retrospective chart review identified all stage I–III endometrial cancer patients who had a hysterectomy with or without complete staging lymphadenectomy and adjuvant radiation therapy between January 2006 and February 2013. Patients with new-onset lymphedema after treatment were identified. Logistic regression was used to find factors that influenced lymphedema risk.ResultsOf 212 patients who met inclusion criteria, 15 patients (7.1%) developed new-onset lymphedema. Lymphedema was associated with lymph-node dissection (odds ratio [OR], 5.6; 95% CI, 1.01 to 105.5; p=0.048) and with the presence of pathologically positive lymph nodes (OR, 4.1; 95% CI, 1.4 to 12.3; p=0.01). Multivariate logistic regression confirmed the association with lymph-node positivity (OR, 3.2; 95% CI, 1.0007 to 10.7; p=0.0499) when controlled for lymph-node dissection. Median time to lymphedema onset was 8 months (range, 1 to 58 months) with resolution or improvement in eight patients (53.3%) after a median of 10 months.ConclusionLymph-node positivity was associated with an increased risk of lymphedema in endometrial cancer patients who received adjuvant radiation. Future studies are needed to explore whether node-positive patients may benefit from early lymphedema-controlling interventions.

Lymphedema after treatment for endometrial cancer − A review of prevalence and risk factors

“…In other studies the median number of removed lymph nodes is significantly higher, up to over 80 [20,27,28,31]. The number of removed lymph nodes seems to be of importance for developing LLL with an increasing risk for LLL when a larger number of lymph nodes are removed [10,21,22,24,[37][38][39][40][41][42]. Interestingly, and with no obvious reasonable pathophysiological explanation, Hareyama et al found a significantly lower risk of LLL in women when the number of removed lymph nodes exceeded 70 [28].…”

“…The occurrence of lymph node metastases in the removed lymph nodes was shown by Mitra et al to be a risk factor for LLL [41], but the results are contradictory [28,43].…”

“…Therefore the populations of EC survivors may also be expected to have higher BMI than the average population. In three of the descriptive studies where the participants answered a questionnaire concerning LLL, higher BMI was significantly associated with more LLL symptoms [34,42,44,45] while in other studies such an association between BMI and risk for LLL was not demonstrated [8,24,28,41,46]. Higher levels of physical activity have been associated with a significantly reduced risk for LLL.…”

Lower Body Lymphedema in Patients with Gynecologic Cancer

“…Some studies have suggested that radiation increases the risk of lymphedema, but most patients in these studies had more than 20 nodes removed, which might increase the risk of lymphedema per se (39,40). In a recent study, the risk of LLL after post-operative radiation (mainly external beam radiation), evaluated through both objective and subjective evaluations, was associated with lymph node positivity (OR=3,2; 95%CI=1.0007-10·7; p=0.0499) when controlled for lymph-node dissection (41).…”

Short commentary on Lymphedema after Treatment for Endometrial Cancer

“…Risk factors remains to be evaluated in correctly designed and sufficiently powered studies. However, lymphadenectomy per se [4][5][6][7], number of lymph nodes removed [6,[8][9][10][11][12][13][14][15][16] and radiotherapy [3, [7][8][9][10][11]14,[17][18][19][20] seem to be established risk factor. Lymphedema onset may begin immediately after surgery or may be delayed for many years.…”