Purpose of review Head and neck lymphedema (HNL) is a common and often debilitating cancer treatment effect that is under-researched and ill defined. We examined current literature and reviewed historical treatment approaches. We propose a model for evaluation and treatment of HNL used at The University of Texas M. D. Anderson Cancer Center (MDACC) for patients with head and neck cancer (HNC). Recent findings Despite the morbidity associated with HNL in patients with HNC, to our knowledge, no article has been published within the past 18 months whose primary focus is HNL. Eight publications included HNL but only as a secondary focus related to treatment effect, risk of dysphagia, prognostic indicator of underlying disease, and quality of life. A potential benefit of Selenium treatment to reduce HNL was reported. Summary This article highlights the recent literature regarding HNL in patients treated for HNC. Although HNL is reported as a potential complication of HNC treatment, no clear definition of the disease or its management are published. Our early experience using an objective evaluation and treatment protocol holds promise for a better understanding of HNL in patients treated for head and neck malignancy.

Objective We sought to describe the presentation of external head and neck lymphedema in patients treated for head and neck cancer and examine their initial response to complete decongestive therapy. Study Design Case series with chart review. Setting MD Anderson Cancer Center, Houston, TX. Subjects and Methods Patients evaluated for head and neck cancer at MD Anderson Cancer Center after treatment 01/2007-01/2013 were retrospectively reviewed. Response to complete decongestive therapy was evaluated per changes in lymphedema severity rating or surface tape measures. Predictors of therapy response were examined using regression models. Results 1,202 patients were evaluated. Most patients (62%) had soft, reversible pitting edema (MDACC Stage 1b). Treatment response was evaluated in 733 patients after receiving therapy; 439 (60%) improved after complete decongestive therapy. Treatment adherence independently predicted complete decongestive therapy response (p<0.001). Conclusions These data support the effectiveness of a head and neck cancer-specific regimen of lymphedema therapy for cancer patients with external head and neck lymphedema. Our findings suggest that head and neck lymphedema is distinct from lymphedema that affects other sites, requiring adaptations in traditional methods of management and measurement.

Lymphedema is a collection of high protein fluid in the interstitial tissues that results from trauma, infection, or oncologic treatment that impairs lymphatic drainage. The damaging effects of radiation therapy and surgery on the lymphatic system primarily include edema and fibrosis. Lymphedema most often is recognized as a potentially serious complication for patients with breast, gynecological, or genitourinary cancers that manifests as swelling of the extremities. However, lymphedema in the head and neck region is a common complication of treatments for head and neck cancer. When lymphedema involves the head and neck region, the cosmetic and functional sequelae may be significant. Potential side effects include problems with drooling, mastication, deglutition, articulation, airway obstruction, and poor self image. The potential effects of head and neck lymphedema on swallowing function have not been well-documented and are only recently recognized. Oral preparation and pharyngeal transit are likely most affected. Complete Decongestive Therapy (CDT) is the international standard of care for treating lymphedema of the extremities that combines manual lymphatic drainage (MLD), bandage compression, skin care, and targeted exercise. Preliminary evidence supports the effectiveness of CDT in patients with head and neck lymphedema after cancer treatment.

Purpose of review Head and neck lymphedema (HNL) is a common and often debilitating cancer treatment effect that is under-researched and ill defined. We examined current literature and reviewed historical treatment approaches. We propose a model for evaluation and treatment of HNL used at The University of Texas M. D. Anderson Cancer Center (MDACC) for patients with head and neck cancer (HNC). Recent findings Despite the morbidity associated with HNL in patients with HNC, to our knowledge, no article has been published within the past 18 months whose primary focus is HNL. Eight publications included HNL but only as a secondary focus related to treatment effect, risk of dysphagia, prognostic indicator of underlying disease, and quality of life. A potential benefit of Selenium treatment to reduce HNL was reported. Summary This article highlights the recent literature regarding HNL in patients treated for HNC. Although HNL is reported as a potential complication of HNC treatment, no clear definition of the disease or its management are published. Our early experience using an objective evaluation and treatment protocol holds promise for a better understanding of HNL in patients treated for head and neck malignancy.

No abstract