Lymphedema outcomes in patients with head and neck cancer

Abstract

Objective: We sought to describe the presentation of external head and neck lymphedema in patients treated for head and neck cancer and to examine their initial responses to complete decongestive therapy.

Study design: Case series with chart review.

Setting: MD Anderson Cancer Center, Houston, Texas.

Subjects and methods: The charts of patients who were evaluated for head and neck cancer at MD Anderson Cancer Center after treatment (January 2007-January 2013) were retrospectively reviewed. Response to complete decongestive therapy was evaluated per changes in lymphedema severity rating or surface tape measures. Predictors of therapy response were examined on the basis of regression models.

Results: The cases of 1202 patients were evaluated. Most patients (62%) had soft reversible pitting edema (MD Anderson Cancer Center stage 1b). Treatment response was evaluated for 733 patients; 439 (60%) improved after complete decongestive therapy. Treatment adherence independently predicted complete decongestive therapy response (P < .001).

Conclusions: These data support the effectiveness of a head and neck cancer-specific regimen of lymphedema therapy for cancer patients with external head and neck lymphedema. Our findings suggest that head and neck lymphedema is distinct from lymphedema that affects other sites, thus requiring adaptations in traditional methods of management and measurement.

Keywords: cancer; head and neck; lymphedema; manual lymphatic drainage; treatment.

© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Figures

Figure 1. Facial Composite

1) Tragus to chin, 2) Tragus to mouth corner, 3) Mandible to nasal wing, 4) Mandible to medial canthus, 5) Mandible to exocanthus, 6) Chin to medial canthus, 7) Mandible to chin Neck Composite - circumferential measures: A) Superior neck, B) Middle neck, C) Inferior neck

Figure 2

Typical progression of response to CDT for HNL.