Quantitative clinical outcomes of therapy for head and neck lymphedema

Kaleigh N Doke, Laine Bowman, Yelizaveta Shnayder, Xinglei Shen, Mindi TenNapel, Sufi Mary Thomas, Prakash Neupane, Hung-Wen Yeh, Chris E Lominska, Kaleigh N Doke, Laine Bowman, Yelizaveta Shnayder, Xinglei Shen, Mindi TenNapel, Sufi Mary Thomas, Prakash Neupane, Hung-Wen Yeh, Chris E Lominska

Abstract

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.

Figures

Figure 1
Figure 1
(A) Individual trajectory of clinically measured neck circumference over time for patients who received lymphedema therapy. (B) Mean percent changes in clinically measured neck circumference over time for patients who received lymphedema therapy. The 95% confidence interval is shown.
Figure 2
Figure 2
Number of patients with improved, stable, or worsened clinically measured neck circumference over time in patients who received lymphedema therapy.
Figure 3
Figure 3
(A). Mean percent change in left cervical range of motion over time in patients who received lymphedema therapy. The 95% confidence interval is shown. (B) Mean percent change in right cervical range of motion over time in patients who received lymphedema therapy. The 95% confidence interval is shown.
Figure 4
Figure 4
Patient-reported pain scores over time of patients with lymphedema therapy.

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Source: PubMed

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