28596 Efficacy of laser CO2 treatment for lymphedema secondary to gynecologic cancer therapy

Abstract

Genital lymphedema is a debilitating possible side effect of gynecologic and pelvic malignancies. With a prevalence of 2-3 million cases in the US, lymphedema is a common chronic inflammatory condition due to lymphatic insufficiency often occurring secondary to surgery, tumor burden, trauma or radiation. Studies estimate 1 in 5 breast cancer patients will experience chronic upper extremity edema; however, other malignancies are less explored. Genital lymphedema may significantly affect quality of life with sequela of lymphorrhea, swelling, and urinary retention. Suggested first line care is non-surgical management; however, no standard recommendations exist. We present a 62-year-old woman with stage IIB grade 3 cervical cancer presenting to dermatologic surgery for evaluation of chronic vulvar lymphedema after total abdominal hysterectomy with bilateral salpingoopherectomy and lymph node dissection with subsequent chemotherapy and pelvic radiation. She developed painful bilateral lower extremity, anterior pelvis and mons pubis lymphedema within two months of treatment. The patient experienced emotional distress due to seven episodes of cellulitis, admissions to the hospital, impaired ability to exercise and decreased aesthetic satisfaction. After failing traditional management with chronic antibiotic therapy, compression stockings and massage therapy and having been rendered a poor surgical candidate for lymph node transfer, she visited dermatology. Six sessions of fractional CO2 laser [Lumenis Deep Fx Fractional CO2 laser, Coherent USA] therapy have been performed with success in decreasing lymphorrhea, edema, and cellulitis episodes allowing stoppage of prophylactic antibiotics. This case explores and highlights the use of fractional CO2 laser therapy for treatment of lymphedema and its sequela.