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.

Conflict of interest statement

Author Disclosure Statement No competing financial interests exist.

Figures

FIG. 1.

Consort flow diagram documenting the number of patients screened, consented, and withdrawn during key study periods.

FIG. 2.

Modeled trajectories of the severity or grade of lymphedema and fibrosis within the sample of patients beginning before treatment and ending 18 months post-treatment. Two distinct trajectory groups were observed for severity of external lymphedema (A, N = 83), internal lymphedema (B, N = 72), and fibrosis (C, N = 83).