Longitudinal Pattern of Lymphedema and Fibrosis in Patients With Oral Cavity or Oropharyngeal Cancer: A Prospective Study

Abstract

Listen

Translate article

PurposeThe study aimed to describe the prevalence, severity, and trajectory of internal lymphedema, external lymphedema, and fibrosis in patients with oral cavity or oropharyngeal (OCOP) cancer. Methods and Materials120 patients with newly diagnosed OCOP cancer were enrolled in a prospective longitudinal study. Recruitment was conducted at a comprehensive medical center. Participants were assessed at pre-treatment, end-of-treatment, 3-, 6-, 9-, and 12-month post-cancer treatment. Validated clinician-reported measures and CT imaging were used to assess the study outcomes. Results76 patients who completed the 9- or 12-month assessments were included in this report. 1) External lymphedema and fibrosis trajectories: The total severity score peaked between end-of-treatment and 3 months post-treatment; reduced gradually over time but did not return to baseline by 12 months post-treatment (p < .001). The longitudinal patterns of severity scores for patients treated with surgery only or with multimodality therapy were similar. 2) Internal swelling trajectories: All patients demonstrated a significant increase in sites with swelling immediately post-treatment. For patients treated with surgery only, swelling was minimal and returned to baseline by 9- to 12 months post-treatment. Patients receiving multi-modal treatment demonstrated a gradual decrease in number of sites with swelling during the 12-month post-treatment period yet remained significantly above baseline (p < .05). 3) CT imaging: Different patterns of changes in prevertebral soft tissue and epiglottic thickness were observed in the surgery-only and multimodality treatment groups during the 12-month post-treatment period. There were minimal changes in thickness in either region in the surgery-only group. Patients with multi-modal treatment had significant increases in thickness in both regions 3 months post-treatment which remained thicker at 12 months than it was at baseline (p <.001). ConclusionLymphedema and fibrosis are common complications of OCOP cancer therapy. Routine assessment, monitoring, and timely treatment of lymphedema and fibrosis are critical.