Prognostic factors for lymphedema in patients with locally advanced head and neck cancer after combined radio(chemo)therapy- results of a longitudinal study. (October 2020)

• Record Type: Journal Article
• Authors: Tribius, Silke; Pazdyka, Henning; Tennstedt, Pierre; Busch, Chia-Jung; Hanken, Henning; Krüll, Andreas; Petersen, Cordula
• Is Part Of: Oral oncology. Volume 109(2020)
• Publication Date: 2020-10
• Subjects: Lymphedema -- Quality of life -- Head and neck cancer -- Intensity-modulated radiotherapy -- Body mass index -- Long term study -- Late toxicity; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2020.104856
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Head and neck lymphedema (HNL) is a common side effect after combined modality treatment. Age, BMI, number of removed nodes, bilateral neck treatment and RT modality predict acute HNL. BMI, RT modality, ECE, bilateral neck treatment and chemotherapy are risk factors for acute grade 2 HNL. BMI, RT modality and ECE are predictors for chronic grade 2 HNL. Tailored surgery and RT techniques will help reduce treatment related toxicities, such as HNL. Abstract: Aim: Treatment-associated lymphedema is a common side effect after multimodal therapy for locally advanced head and neck cancer (LAHNC). This study aims to evaluate potential prognostic factors for head and neck lymphedema (HNL) and its potential impact on clinical outcome. Methods: This is a prospective data registry analysis on 280 patients treated for locally advanced head and neck cancer (LAHNC). All patients received surgery and risk-adapted platinum-based adjuvant intensity modulated radio(chemo)therapy (R(C)T, IMRT). Treatment- related toxicity was prospectively registered in a data base in regular intervals (baseline 3 months after R(C)T, every 3 months for 3 years, and every 6 months thereafter) and documented according to RTOG/EORTC toxicity criteria. Results: Predictive for any grade HNL 3 months after R(C)T were age, BMI, number of removed nodes and RT modality. Multivariable logistic regression analysis showed that in the acute toxicity phase (3 months after R(C)T) higher body mass index (BMI), extracapsular spread (ECE), linac-based IMRT, bilateral treatment to the neck (surgery and RT), and the addition of chemotherapy increase the risk for grade 2 HNL. For chronic HNL, higher BMI, linac-based IMRT and ECE were predictive for grade 2 HNL. Higher BMI is associated with better local control rates. Advanced age and ECE had a negative impact on OS. Conclusion: HNL is a common acute and late side effect after multimodal therapy for LAHNC. Knowing risk factors for HNL prior to therapy enables caregivers and patients to take measures prior to treatment to prevent or limit the effects of HNL.