Pilot Study: Pneumatic Compression Garment Therapy for Postradiotherapy Laryngopharyngeal Edema

Abstract

Objectives: Pneumatic compression garment therapy (PCGT) has been established as treatment for postradiotherapy lymphedema, and its use in head and neck patients is becoming more common. Although effects on interstitial edema of the cervical soft tissues have been studied, effects on internal laryngopharyngeal edema, as well as associated symptoms of dysphagia and dysphonia, have yet to be published. Methods: We surveyed 7 patients treated with radiation for head and neck cancer (HNC) who had also been prescribed PCGT for cervical lymphedema. Patients were asked about subjective experience with the device, and also administered the Eating Assessment Tool-10 (EAT-10) and Voice Handicap Index-10 (VHI-10) surveys regarding their symptoms after using PCGT. Laryngoscopy videos from these same periods were also reviewed and scored using a validated tool for assessing laryngopharyngeal edema. Results: 85% of patients reported at least some improvement in dysphagia and dysphonia following PCGT. Average EAT-10 score after PCGT was 11.4 and average VHI-10 score after PCGT was 8.7. These compare more favorably to historical scores for the same questionnaires in similar patient populations. Laryngeal edema scores on endoscopic examination were not significantly different after at least 3 months of therapy (pre: 20.15, post: 20.21, P = .975); however, the utility of this result is limited by a low inter-rater reliability (Krippendorff α = .513). Conclusions: While we are unable to show any difference in objective assessment of laryngopharyngeal edema on endoscopic examination in this small pilot study, patients report substantial subjective improvement in postradiotherapy dysphagia and dysphonia following cervical PCGT that warrants more formal investigation.

Rehabilitation Interventions for Head and Neck Cancer–Associated Lymphedema

“…Of 1642 unique citations identified by the search, 24 citations (1.5%) met the inclusion criteria, representing 23 unique studies (n = 2147 patients); 1 study produced 2 unique citations that reported different outcomes . Of the 23 studies, 6 were RCTs (26.1%) and 17 (73.9%) were observational studies (Figure).…”

“…The median number of participants was 34 (range, 7-1202). Most studies had fewer than 50 participants (12 of 17 studies). Anatomical disease sites were mixed HNC in all studies.…”

“…When baseline lymphedema was assessed (4 of 17 studies), all studies reported stages 1b (range, 0-3) on the MDACC-HNL Rating Scale . Serious intervention-related adverse effects were either not found (7 studies) or not reported (10 studies) . The timing of interventions was mostly posttreatment except for 1 study intervention that included patients who were undergoing cancer treatment .…”

Systematic review of head and neck lymphedema assessment

“…For internal lymphedema, clinician‐reported assessment consists exclusively of rating scales based on appearance on laryngoscopy. Unlike for external lymphedema, there is relative consensus in the literature on the optimal grading criteria for assessment of internal lymphedema, with the Patterson Edema Scale selected as the reference tool in the vast majority of studies in the last decade 1–3,8,14,32–34,48–53 . An alternative, the Late Effects Normal Tissue‐Subjective, Objective, Management, Analytic (LENT‐SOMA) Scale, was utilized in several earlier papers but does not take into account pharyngeal lymphedema and has received less attention 37,38 .…”

“…Unlike for external lymphedema, there is relative consensus in the literature on the optimal grading criteria for assessment of internal lymphedema, with the Patterson Edema Scale selected as the reference tool in the vast majority of studies in the last decade. [1][2][3]8,14,[32][33][34][48][49][50][51][52][53] An alternative, the Late Effects Normal Tissue-Subjective, Objective, Management, Analytic (LENT-SOMA) Scale, was utilized in several earlier papers but does not take into account pharyngeal lymphedema and has received less attention. 37,38 The Patterson Scale assesses 11 structures and 2 spaces, with a rating from normal to severe.…”