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Dysphagia

pp 1–13 | Cite as

Cervicofacial and Pharyngolaryngeal Lymphedema and Deglutition After Head and Neck Cancer Treatment

  • Débora dos Santos QueijaEmail author
  • Rogério Aparecido Dedivitis
  • Lica Arakawa-Sugueno
  • Mario Augusto Ferrari de Castro
  • Bruna Mello Chamma
  • Marco Aurélio Vamondes Kulcsar
  • Leandro Luongo de Matos
Original Article
  • 60 Downloads

Abstract

One of the sequelae of head and neck cancer treatment is secondary lymphedema, with important impact on breathing, swallowing and vocal functions. The aim of the study was to assess the presence, staging characteristics and relationship of external and internal lymphedema and dysphagia after head and neck cancer treatment. The MDACC Lymphedema Rating Scale in Head and Neck Cancer was employed for the assessment and staging of face and neck lymphedema; the Radiotherapy Edema Scale for internal lymphedema; and a fiberoptic endoscopic evaluation of swallowing (FEES) for swallowing. The sample consisted of 46 patients with a diagnosis of head and neck cancer. Lymphedema was detected in 97.8% (45) of the evaluations with predominance of the composite type (73.9%—34). A high percentage of external lymphedema of the neck (71.7%—33) and submandibular (63%—29) were detected, with predominance of the more advanced levels. Internal edema was found in almost all structures and spaces at moderate/severe level. At FEES, residue (higher percentage in valleculae and pyriform sinus), penetration and aspirations were observed. The residue was detected in higher occurrence in patients with composite lymphedema (p = 0.012). The combined treatment with radiotherapy was related to submandibular external lymphedema (p = 0.009), altered pharyngolaryngeal sensitivity (0.040), presence of residue (p = 0.001) and penetration to pasty (p = 0.007) and internal edema in almost all structures. There was also a higher percentage of residue in cases with internal altered pharyngolaryngeal sensitivity, residue, penetration and aspiration. Combined treatment with radiotherapy is an associated factor of edema. Cervicofacial and pharyngolaryngeal lymphedema is a frequent event after treatment for HNC, with important impact on swallowing performance characterised by altered pharyngolaryngeal sensitivity, residue, penetration and aspiration. Combined treatment with radiotherapy is an associated factor.

Keywords

Lymphedema Head and neck neoplasms Neck dissection Radiotherapy Deglutition disorders Deglutition 

Notes

Author Contributions

All authors have read and approved the paper.

Funding

There is no sources of outside support for research.

Compliance with Ethical Standards

Conflict of interest

There are no personal conflicts of interest of any of the authors.

Ethical Approval

The authors state that the material has not been previously published or submitted elsewhere for publication and will not be sent to another journal until a decision is made concerning publication by Dysphagia. It conforms with the regulations currently in force regarding research ethics study and approved by the institute’s Ethics Committee for Research, number 137/14. The work was performed in accordance with the principles of the current version of the Declaration of Helsinki.

References

  1. 1.
    Pignon JP, Le Maitre A, Maillard E, Bourhis J, MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update of 93 trials and 17, 346 patients. Radiother Oncol. 2009;92:4–14.CrossRefGoogle Scholar
  2. 2.
    Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, Glisson B, Trotti A, Ridge JA, Chao C, Peters G, Lee DJ, Leaf A, Ensley J, Cooper J. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349:2091–8.CrossRefGoogle Scholar
  3. 3.
    Bentzen SM, Dörr W, Anscher MS, Denham JW, Hauer-Jensen M, Marks LB, Williams J. Normal tissue effects: reporting and analysis. Semin Radiat Oncol. 2003;13:189–202.CrossRefGoogle Scholar
  4. 4.
    Deng J, Ridner SH, Dietrich MS, Wells N, Wallston KA, Sinard RJ, Cmelak AJ, Murphy BA. Prevalence of secondary lymphedema in patients with head and neck cancer. J Pain Symptom Man. 2012;43(2):244–52.CrossRefGoogle Scholar
  5. 5.
    Deng J, Murphy BA, Dietrich MS, Wells N, Wallston KA, Sinard RJ, Cmelak AJ, Gilbert J, Ridner SH. Impact of secondary lymphedema after head and neck cancer treatment on symptoms, functional status, and quality of life. Head Neck. 2013;35(7):1026–35.CrossRefGoogle Scholar
  6. 6.
    Deng J, Murphy BA, Dietrich MS, Sinard RJ, Mannion K, Ridner SH. Differences of symptoms in head and neck cancer patients with and without lymphedema. Support Care Cancer. 2016;24:1305–16.CrossRefGoogle Scholar
  7. 7.
    Smith BG, Hutcheson KA, Little LG, Skoracki RJ, Rosenthal DI, Lai SY, Lewin JS. Lymphedema outcomes in patients with head and neck cancer. Otolaryngol Head Neck Surg. 2015;152(2):284–91.CrossRefGoogle Scholar
  8. 8.
    Lazarus CL, Husaini H, Hu K, Culliney B, Li Z, Urken M, Jacobson A, Persky M, Tran T, Concert C, Palacios D, Metcalfe-Klaw R, Kumar M, Bennett B, Harrison L. Functional outcomes and quality of life after chemoradiotherapy: baseline and 3 and 6 months post-treatment. Dysphagia. 2014;29(3):365–75.CrossRefGoogle Scholar
  9. 9.
    Silveira MH, Dedivitis RA, Queija DS, Nascimento PC. Quality of life in swallowing disorders after nonsurgical treatment for head and neck cancer. Int Arch Otorhinolaryngol. 2015;19:46–54.CrossRefGoogle Scholar
  10. 10.
    Portas J, Socci CP, Scian EP, Queija DS, Ferreira AS, Dedivitis RA, Barros APB. Swallowing after non-surgical treatment (radiation therapy/radiochemotherapy protocol) of laryngeal cancer. Braz J Otorhinolaryngol. 2011;77(1):96–101.CrossRefGoogle Scholar
  11. 11.
    Lazarus CL. Effects of chemoradiotherapy on voice and swallowing. Curr Opin Otolaryngol Head Neck Surg. 2009;17(3):172–8.CrossRefGoogle Scholar
  12. 12.
    Queija DS, Portas JG, Dedivitis RA, Lehn CN, Barros APB. Swallowing and quality of life after total laryngectomy and pharyngolaryngectomy. Braz J Otorhinolaryngol. 2009;75(4):556–64.CrossRefGoogle Scholar
  13. 13.
    Portas JG, Queija DS, Arine LP, Ferreira AS, Dedivitis RA, Lehn CN, Barros APB. Voice and swallowing disorders: functional results and quality of life following supracricoid laryngectomy with cricohyoidoepiglottopexy. Ear Nose Throat J. 2009;88(10):E23–30.Google Scholar
  14. 14.
    Kowalski LP, Sanabria A. Elective neck dissection on oral carcinoma: a critical review of the evidence. Acta Othorhinolaryngol Ital. 2007;27:113–7.Google Scholar
  15. 15.
    Murphy BA, Gilbert J. Dysphagia in head and neck cancer patients treated with radiation: assessment, sequelae, and rehabilitation. Semin Radiat Oncol. 2009;19(1):35–42.CrossRefGoogle Scholar
  16. 16.
    Deng J, Ridner SH, Dietrich MS, Wells N, Wallston KA, Sinard RJ, Cmelak AJ, Murphy BA. Factors associated with external and internal lymphedema in patients with head and neck cancer. Int J Radiation Oncol Biol Phys. 2012;84:319–28.CrossRefGoogle Scholar
  17. 17.
    Smith BG, Lewin JS. Lymphedema management in head and neck cancer. Curr Opin Otolaryngol Head Neck Surg. 2010;18:153–8.CrossRefGoogle Scholar
  18. 18.
    Lymphoedema framework. Best practice for the management of lymphoedema. International consensus. London: MEP. 2006.Google Scholar
  19. 19.
    Queija DS, Arakawa-Sugueno L, Chamma BM, Kulcsar MA, Dedivitis RA. Tradução e adaptação para o português brasileiro da Lymphedema Rating Scale in Head and Neck Cancer. Einstein. 2017;15(4):457–64.CrossRefGoogle Scholar
  20. 20.
    Patterson JM, Hildreth A, Wilson JA. Measuring edema in irradiated head and neck cancer patients. Ann Otol Rhinol Laryngol. 2007;116(8):559–64.CrossRefGoogle Scholar
  21. 21.
    Földi MD, Földi E, Strössenreuther RHK, Kubik S. Földi’s textbook of lymphology: for physicians and lymphedema therapists. 2a ed. Munich: Urban and Fischer; 2007.Google Scholar
  22. 22.
    Deng J, Dietrich MS, Ridner SH, Fleischer AC, Wells N, Murphy BA. Preliminary evaluation of reliability and validity of head and neck external lymphedema and fibrosis assessment criteria. Eur J Oncol Nurs. 2016;22:63–70.CrossRefGoogle Scholar
  23. 23.
    Purcell A, Nixon J, Fleming J, McCann A, Porceddu S. Measuring head and neck lymphedema: the ALOHA trial. Head Neck. 2016;38(1):79–84.CrossRefGoogle Scholar
  24. 24.
    Pigott A, Nixon J, Fleming J, Porceddu S. Head and neck lymphedema management: evaluation of a therapy program. Head Neck. 2018;40(6):1131–7.CrossRefGoogle Scholar
  25. 25.
    Gutierrez C, Karni RJ, Naqvi S, Aldrich MB, Zhu B, Morrow JR, Sevick-Muraca EM, Rasmussen JC. Head and neck lymphedema: treatment response to single and multiple sessions of advanced pneumatic compression therapy. Otolaryngol Head Neck Surg. 2019;160(4):622–6.CrossRefGoogle Scholar
  26. 26.
    Queija DS, Arakawa-Sugueno L, Chamma BM, Kulcsar MA, Dedivitis RA. Translation and adaptation of the radiotherapy edema rating scale to Brazilian Portuguese. Braz J Otorhinolaryngol. 2018;84(3):344–50.CrossRefGoogle Scholar
  27. 27.
    Jung SH, Kim J, Jeong H, Lee SU. Effect of the order of test diets on the accuracy and safety of swallowing studies. Ann Rehabil Med. 2014;38(3):304–9.CrossRefGoogle Scholar
  28. 28.
    Rosenbek JC, Robbins J, Roecker EV, Coyle JL, Woods JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.CrossRefGoogle Scholar
  29. 29.
    Ridner SH, Dietrich MS, Niermann K, Cmelak A, Mannion K, Murphy B. A prospective study of the lymphedema and fibrosis continuum in patients with head and neck cancer. Lymphat Res Biol. 2016;14(4):198–205.CrossRefGoogle Scholar
  30. 30.
    Rasmussen JC, Tan IC, Naqvi S, Aldrich MB, Maus EA, Blanco AI, Karni RJ, Sevick-Muraca EM. Longitudinal monitoring of the head and neck lymphatics in response to surgery and radiation. Head Neck. 2017;39(6):1177–88.CrossRefGoogle Scholar
  31. 31.
    Ridner SH, Dietrich MS, Sonis ST, Murphy B. Biomarkers associated with lymphedema and fibrosis in patients with cancer of thr head and neck. Lymphat Res Biol. 2018;16(6):516–24.CrossRefGoogle Scholar
  32. 32.
    Jackson LK, Ridner SH, Deng J, Bartow C, Mannion K, Niermann K, Gilbert J, Dietrich MS, Cmelak AJ, Murphy BA. Internal lymphedema correlates with subjective and objective measures of dysphagia on head and neck cancer patients. J Paliat Med. 2016;19(9):949–56.CrossRefGoogle Scholar
  33. 33.
    Avraham T, Yan A, Zampell JC, Daluvoy SV, Haimovitz-Friedman A, Cordeiro AP, Mehrara BJ. Radiation therapy causes loss of dermal lymphatic vessels and interferes with lymphatic function by TGF-beta1-mediated tissue fibrosis. Am J Physiol Cell Physiol. 2010;299:C589–605.CrossRefGoogle Scholar
  34. 34.
    Delanian S, Lefaix JL. Current management for late normal tissue injury: radiation-induced fibrosis and necrosis. Semin Radiat Oncol. 2007;17:99–107.CrossRefGoogle Scholar
  35. 35.
    Meyer TK, Pisegna JM, Krisciunas GP, Pauloski BR, Langmore SE. Residue influences quality of life independently of penetration and aspiration in head and neck cancer survivor. Laryngoscope. 2017;127(7):1615–21.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Débora dos Santos Queija
    • 1
    Email author
  • Rogério Aparecido Dedivitis
    • 2
  • Lica Arakawa-Sugueno
    • 1
  • Mario Augusto Ferrari de Castro
    • 3
  • Bruna Mello Chamma
    • 4
  • Marco Aurélio Vamondes Kulcsar
    • 2
    • 5
  • Leandro Luongo de Matos
    • 2
  1. 1.São Paulo Medical SchoolUniversity of São PauloSão PauloBrazil
  2. 2.Department of Head and Neck Surgery, São Paulo Medical SchoolUniversity of São PauloSão PauloBrazil
  3. 3.Medical SchoolUniversity Metropolitana of SantosSantosBrazil
  4. 4.Mogi das Cruzes UniversityMogi das CruzesBrazil
  5. 5.São Paulo State Cancer InstituteSão PauloBrazil

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