Quantitative clinical outcomes of therapy for head and neck lymphedema

Kaleigh N. Doke MD, Laine Bowman MA, , Yelizaveta Shnayder MD, Xinglei Shen MD, Mindi TenNapel, Sufi Mary Thomas, Prakash Neupane, Hung-Wen Yeh, Chris E. Lominska. Advances in Radiation Oncology (2018) 3, 366–371

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Quantitative clinical outcomes of therapy for head and neck lymphedema

Kaleigh N. Doke MD, Laine Bowman MA, , Yelizaveta Shnayder MD, Xinglei Shen MD, Mindi TenNapel, Sufi Mary Thomas, Prakash Neupane, Hung-Wen Yeh, Chris E. Lominska. Advances in Radiation Oncology (2018) 3, 366–371

Purpose: Head and neck surgery and radiation cause tissue fibrosis that leads to functional limitations and lymphedema. The objective of this study was to determine whether lymphedema therapy after surgery and radiation for head and neck cancer decreases neck circumference, increases cervical range of motion, and improves pain scores.

Methods and materials: A retrospective review of all patients with squamous cell carcinoma of the oral cavity, oropharynx, or larynx who were treated with high-dose radiation therapy at a single center between 2011 and 2012 was performed. Patients received definitive or postoperative radiation for squamous cell carcinoma of the oral cavity, oropharynx, or larynx. Patients were referred to a single, certified, lymphedema therapist with specialty training in head and neck cancer after completion of radiation treatment and healing of acute toxicity (typically 1-3 months). Patients underwent at least 3 months of manual lymphatic decongestion and skilled fibrotic techniques. Circumferential neck measurements and cervical range of motion were measured clinically at 1, 3, 6, 9, and 12 months after completion of radiation therapy. Pain scores were also recorded.

Results: Thirty-four consecutive patients were eligible and underwent a median of 6 months of lymphedema therapy (Range, 3-12 months). Clinically measured total neck circumference decreased in all patients with 1 month of treatment. Cervical rotation increased by 30.2% on the left and 27.9% on the right at 1 month and continued to improve up to 44.6% and 55.3%, respectively, at 12 months. Patients undergoing therapy had improved pain scores from 4.3 at baseline to 2.0 after 1 month.

Conclusions: Lymphedema therapy is associated with objective improvements in range of motion, neck circumference, and pain scores in the majority of patients.

Main findings

  • Of the 34 patients who received lymphedema therapy, 27 patients had a PEG tube placed during radiation treatment to allow for supplemental nutrition.
  • Patients with head and neck cancer with lymphedema had improvement in neck circumference after receiving manual lymphatic decongestion from a certified lymphedema therapist. More than 90% of patients showed either stability or improvement at all time points and lymphedema therapy prevented the worsening progression of edema. With more therapy from 1 to 3 months, more patients saw improvements of >2%. Furthermore, patients tended to see larger changes in neck circumference over time.
  • Patients undergoing therapy also saw steady clinical improvements in cervical range of motion after the first treatment each month until the completion of therapy.
  • This study is limited in that there is no control group of patients who received head and neck RT and clinical measurements to compare with the group of patients who received lymphedema therapy.