Treatment approaches and outcomes of a head and neck lymphedema service at an Australian comprehensive cancer center

Lymphedema management in patients with head and neck cancer: a systematic review of randomized controlled trials on physical therapy interventions

PURPOSE

Lymphedema is one of the most common side effects following oncological treatment. This systematic review analyzed the latest literature concerning the efficacy of physical therapy interventions in treating secondary lymphedema in patients with head and neck cancer.

METHODS

Medline, Web of Science, Scopus, and Cochrane Library were searched for studies published before August 2023. Randomized controlled trials in which physical therapy was applied to treat lymphedema in head and neck cancer were included. Reviewers blinded screened the articles retrieved, scored methodological quality, and extracted data. The review was conducted according to the PRISMA statement and registered in PROSPERO (CRD42023439643). Risk of bias assessment was performed using the Cochrane tools.

RESULTS

A total of four randomized controlled trials were included. They comprise 167 patients, and only one of the studies achieved a low risk of bias. Interventions were kinesio taping, compression therapy, manual lymphatic drainage and/or exercise applied in combination with skin care and self-management. Some adverse effects related to intervention were mild and transitory.

CONCLUSION

The findings shown by this review were that an exercise program plus manual lymphatic drainage supplemented with kinesio taping or compression therapy could be beneficial for external lymphedema. Neither therapy achieved an improvement in internal lymphedema.

Feasibility and efficacy of home-based lymphedema exercises for head and neck cancer patients at a safety net hospital

PURPOSE

Lymphedema therapy is an effective tool in mitigating head and neck lymphedema morbidity and long-term fibrosis. Studies have shown the efficacy of facility-based therapy; however, access can be limited by sociodemographic factors, including socioeconomic status and transportation. This study evaluates the feasibility and effectiveness of home-based lymphedema therapy in a socially vulnerable patient population.

MATERIALS AND METHODS

A retrospective chart review analyzed patients who underwent home-based lymphedema exercise regimen after training with a lymphedema-trained speech language pathologist between 2019 and 2022 at a tertiary academic medical center. Patient and cancer demographics were collected. Primary outcomes measured were quality of life surveys and diet status.

RESULTS

Of the 27 patients included, 85.1 % were in the two highest quintiles of neighborhood deprivation based on national Area Deprivation Index (ADI). Treatment breakdown included 78 % who were treated with surgery, 96 % completed radiation and 59.3 % chemotherapy. Six months after initiating lymphedema therapy, most patients (59.3 %) were compliant with exercises. Quality of life scores showed trends toward improvement, but only a decrease in condition-related anxiety at 3 months (p = 0.004) reached statistical significance. Improvement in diet was significant at 6 and 9 months after initiation of treatment (p = 0.020).

CONCLUSIONS

Patient compliance rate demonstrates feasibility of home exercises for lymphedema treatment in a tertiary care setting with a socially vulnerable patient population. Home-based head and neck lymphedema treatment showed improvements in patient diet over time.

Multidisciplinary therapeutic strategy with appropriate timing and modalities for treating cervicofacial lymphatic malformations in children

PURPOSE

The study reviewed a multidisciplinary approach to treating cervicofacial lymphatic malformations (CFLMs) in children.

METHODS

Between 2007 and 2023, 53 children with CFLMs were treated with the median on-set age of 5 months (0-165) at our institute. For infants, airway management, including possible tracheotomy was prioritized, and a "wait-and-see" policy was adopted to expect spontaneous regression. Once children reached one year of age or diagnosed after infancy, OK-432 sclerotherapy and surgical treatment with/without sirolimus were considered for residual lesions.

RESULTS

The median follow-up period was 38 months (0-169). Among 30 infants, tracheostomy was performed in 4 patients, with 3 successfully closed after treatment. Thirteen patients showed excellent improvement without treatment. Sclerotherapy was performed in 15 patients, and partial resection in 5. Six patients were treated with sirolimus and showed moderate shrinkage or cessation of bleeding. Overall, 23 of 30 infants showed moderate to excellent improvement. For the 23 patients diagnosed after infancy, 16 improved without treatment, and 7 showed moderate to excellent improvement with sclerotherapy.

CONCLUSIONS

The study concluded that early sclerotherapy for infants, particularly around the airway, poses risks, and tracheostomy might be necessary. The comprehensive strategy including "wait-and-see," sclerotherapy, sirolimus treatment, and timely surgery significantly improved the patients' quality of life.

Lymphedema of the Head and Neck-Where Do We Stand and Where We Are Headed

Great advancements have been made in the management of lymphedema of the extremities with lymphatic surgery. However, lymphedema of other regions, including head and neck, has remained neglected. Recent discovery of lymphatic system in the brain and the communication between intracranial and paracranial lymphatic systems has drawn attention to the head and neck lymphatics. Lymphedema of the head and neck region can result from inherent abnormality of the lymphatic system (primary) or be caused by accidental or iatrogenic injury to lymphatics (secondary). The head and neck contain a large network of lymphatic tissue. They may be affected by direct tumor infiltration, surgical resection of tumors and surrounding cancer tissue, and/or radiotherapy. Proper screening and counseling of patients before facial aesthetic procedures may avoid managing the distress of lymphedema postprocedure. Progression of head and neck lymphedema (HNL) can lead to chronic inflammatory, fibrosclerotic, and fibrofatty deposition, resulting in permanent deformity and disability. Patients may experience functional impairment, including skin changes, pain, range of motion limitations, contracture, dysphagia, dysarthria, dyspnea, and trismus, all leading to reduced quality of life. Despite these known disabilities, HNL is underdiagnosed due to a lack of awareness about this entity and of tools available for measuring internal or external swelling. The authors' article comprehensively reviews the current diagnostic methods and management strategies and what lies ahead.

Patient-reported outcome measures and physical function following head and neck lymphedema - a systematic review

PURPOSE

Head and neck cancer (HNC) treatments often lead to significant morbidity, including lymphedema. This systematic review aims to comprehensively explore the prevalence and impact of head and neck lymphedema (HNL) following treatment.

METHODS

A systematic literature search was conducted up to September 2023. Studies evaluating HNL prevalence, associated factors, impact, patient-reported outcomes (PROMs), and physical assessments were included. Methodological quality assessment was performed, and data were synthesised narratively.

RESULTS

Twelve studies met the inclusion criteria, with methodological quality ranging from moderate to high. Internal lymphedema prevalence was consistently higher than external lymphedema, with varying rates attributed to treatment modalities and assessment methods. PROMs such as the Lymphedema Symptom Intensity and Distress-Head and Neck and physical assessments including Patterson's Rating Scale were commonly utilised. HNL significantly impacted quality of life and physical function, with reported symptoms including discomfort, tightness, swallowing difficulties, and psychological distress.

CONCLUSION

HNL is a common sequela of HNC treatment with significant implications for individuals' QoL. Standardised assessment protocols and tailored interventions are needed to address the needs of individuals with HNL and improve overall outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

This systematic review highlights a significant prevalence of lymphedema, particularly internal lymphedema in the larynx and pharynx, following treatment. Swallowing difficulties, nutritional issues, anxiety, depression, and body image concerns were associated with both internal and external lymphedema. The impact on quality of life is substantial, with survivors experiencing physical symptoms and psychosocial challenges, emphasising the importance of integrated care approaches tailored to both aspects of well-being.

Innovative Strategies in Microvascular Head and Neck Reconstruction

The field of reconstructive microsurgery has witnessed considerable advancements over the years, driven by improvements in technology, imaging, surgical instruments, increased understanding of perforator anatomy, and experience with microsurgery. However, within the subset of microvascular head and neck reconstruction, novel strategies are needed to improve and optimize both patient aesthetics and post-operative function. Given the disfiguring defects that are encountered following trauma or oncologic resections, the reconstructive microsurgeon must always aim to innovate new approaches, reject historic premises, and challenge established paradigms to further achieve improvement in both aesthetic and functional outcomes. The authors aim to provide an up-to-date review of innovations in head and neck reconstruction for oncologic defects.