Lower Extremity Lymphedema in Gynecologic Cancer Patients: Propensity Score Matching Analysis of External Beam Radiation versus Brachytherapy.

Won Ick Chang,Seung Hyuck Jeon,Noh Hyun Park,Yong Sang Song,Maria Lee,Hee Seung Kim,Hong-Gyun Wu,Hyun Hoon Chung,Hyun-Cheol Kang,Hak Jae Kim,Kwan-Sik Seo,Jae Weon Kim

doi:10.3390/cancers11101471

Won Ick Chang, Seung Hyuck Jeon + Show 10 more

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https://doi.org/10.3390/cancers11101471

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Journal: Cancers	Publication Date: Sep 30, 2019
Citations: 6	License type: CC BY 4.0

Affiliation: Seoul National University

Abstract

The goal of this study is to compare the risk of lower extremity lymphedema (LEL) between pelvic external beam radiation therapy (EBRT) and vaginal brachytherapy, and to identify risk factors for LEL in gynecologic cancer patients treated with adjuvant radiation therapy (RT) after radical surgery. A total of 263 stage I–III gynecologic cancer patients who underwent adjuvant RT were retrospectively reviewed. One-to-one case-matched analysis was conducted with propensity scores generated from patient, tumor, and treatment characteristics. Using the risk factors found in this study, high- and low-risk groups were identified. With a median follow-up of 36.0 months, 35 of 263 (13.3%) patients developed LEL. In multivariate analysis, laparoscopic surgery (HR 2.548; p = 0.024), harvesting more than 30 pelvic lymph nodes (HR 2.246; p = 0.028), and para-aortic lymph node dissection (PALND, HR 2.305; p = 0.014) were identified as independent risk factors for LEL. After propensity score matching, the LEL incidence of the brachytherapy group was significantly lower than the EBRT group (p = 0.025). In conclusion, high-risk patients with risk factors such as laparoscopic surgery, harvesting more than 30 pelvic lymph nodes, PALND, and adjuvant pelvic EBRT require closer observation for LEL.

Highlights

Lower extremity lymphedema (LEL) is a complication impairing quality of life in gynecologic cancer patients following radical surgical treatment [1,2]
More than 30 pelvic lymph nodes were harvested in 20.5% of the patients, and para-aortic lymph node dissection (PALND)
AUC value of predicting lower extremity lymphedema (LEL) with this risk group classification was 0.675, 0.669, and 0.662 for LEL at 1, 3 and 5 years after surgery. This retrospective study showed that laparoscopic surgery, harvesting more than 30 pelvic lymph nodes, and PALND were associated with a higher incidence of LEL, and that adjuvant pelvic external beam radiation therapy (EBRT)

Summary

Introduction

Lower extremity lymphedema (LEL) is a complication impairing quality of life in gynecologic cancer patients following radical surgical treatment [1,2]. This complication is quite common, with a reported incidence ranging from 3.6% up to 47.0% [3,4]. Many studies have been reported to identify risk factors for LEL in Cancers 2019, 11, 1471; doi:10.3390/cancers11101471 www.mdpi.com/journal/cancers. Adjuvant radiation therapy (RT) is well known to be associated with higher incidence of LEL, regardless of the cancer origin [4,8,9,10], with an approximately 3-fold increased risk in several studies [4,9,10,11,12,13]

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