Lymphedema in Head/Neck Cancer Issues

Treatment of head and neck cancer causes potentially severe lymphedema, which responds to complete decongestive therapy in most cases, a retrospective chart review showed.

The most severe lymphedema occurred in patients treated with surgery and radiation therapy, followed by definitive surgery alone. Complete decongestive therapy led to clinical improvement in a majority of the patients, including 83% of those treated with surgery alone.

"Lymphedema is vastly under-recognized and under-reported in patients with head and neck cancer," Jan S. Lewin, PhD, of M.D. Anderson Cancer Center in Houston, said in an interview at the Multidisciplinary Head and Neck Cancer Symposium.

"The lymphedema can be just as severe as what's seen after treatment of breast and other types of cancer. Lymphedema in patients with head and neck cancer can be terribly disfiguring and cause severe functional problems."

"Complete decongestive therapy leads to clinically significant improvement in most patients, whether it's performed in a clinic or at home," she added.

Available evidence suggests that fewer than half of patients with head and neck cancer develop lymphedema after treatment. However, cosmetic and functional sequelae can be severe, including problems with speaking, eating, airway obstruction, and drooling, as well as self-image.

As compared with lymphedema in other cancers, a paucity of information exists about the presentation and treatment of the condition in patients with head and neck cancer, said Lewin.

In an effort to add to the information base, she and her colleagues retrospectively reviewed records of patients referred for evaluation of lymphedema following treatment of head and neck cancer.

Data collection included patient and disease characteristics, site and severity of lymphedema, and the type of complete decongestive therapy each patient received (outpatient or at home).

Investigators stratified patients by type of cancer treatment and decongestive therapy regimen. Outcomes were assessed by clinical examination, and improvement was defined as a reduction in lymphedema stage, resolution of the lymphedema site, or ≥2% decrease in total surface area affected.

Complete decongestive therapy conformed to recognized standards and consisted of manual lymphatic drainage massage, use of compression bandages, physical exercise, and a skin-care regimen.

Outpatient therapy was performed by a certified therapist and consisted of an intensive phase of three to five sessions weekly for two to four weeks, followed by maintenance home therapy.

Patients who were unwilling or unable to complete the outpatient regimen were assigned to a self-administered home-based regimen.

The study population consisted of 270 patients, 30% of whom were treated with definitive external beam radiation therapy, 9% with surgery alone, and 61% with surgery and radiation therapy.

The neck was the most common site of lymphedema (89%), followed by the submental (84%), facial (32%), and intraoral (6%) areas. Some patients had more than one affected area.

Lewin reported that 53% of the patients had moderately severe lymphedema, defined as M.D. Anderson stage 1b (reversible, pitting edema). Combined therapy resulted in significantly worse lymphedema (P=0.001).

Overall, 161 (60%) patients reported functional problems related to lymphedema, including difficulty swallowing in 80 patients (30%) and speech problems in 31 (11%).

Outcome data were available for 152 patients who received complete decongestive therapy and returned for follow-up evaluation (an average of 10.7 weeks after initial evaluation).

Lewin and colleagues found that 54% (82 of 152) of patients had improved clinically at follow-up (15 of 20 who had outpatient therapy and 67 of 132 who had home-based therapy).

Improvement was observed in 83% of patients treated by surgery alone, 55% of patients treated with definitive radiation therapy, and 49% of patients treated with surgery and radiation.

Evaluation of functional outcomes is ongoing, said Lewin.

Lewin and her co-investigators had no disclosures.

Primary source: Multidisciplinary Head and Neck Cancer Symposium

Source reference:

Lewin JS, et al "Early experience with head and neck lymphedema after treatment for head and neck cancer" MHNCS 2010; Abstract 45.

MEDSCAPE March 2010

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