Treatment for lymphedema following head and neck cancer therapy: A systematic review
Author links open overlay panelAlbinaTykeraJoelFrancobSean T.MassacShaun C.DesaidScott G.Walenb
a
Saint Louis University School of Medicine, 1402 S Grand Blvd, St. Louis, MO 63104, United States of America
b
Saint Louis University Department of Otolaryngology, 3665 Vista Ave, St. Louis, MO 63110, United States of America
c
Washington University in Saint Louis Department of Otolaryngology, 1 Barnes-Jewish Hospital Plaza, St. Louis, MO 63110, United States of America
d
Johns Hopkins University School of Medicine, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, 601 N Caroline St, Baltimore, MD 21287, United States of America
Received 5 May 2019, Available online 30 May 2019.
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https://doi.org/10.1016/j.amjoto.2019.05.024Get rights and content
Abstract
Objective
To perform the first systematic review evaluating all established treatment modalities of head and neck lymphedema resulting from head and neck cancer therapy. Since craniofacial lymphedema treatment represents unique challenges not addressed by extremity lymphedema therapies, a systematic review and evaluation of treatment modalities specific to this area is needed to guide clinical management and further research.
Data sources
Four electronic databases were searches from inception to September 2018. These included Scopus (Embase), PubMed (Medline), Clinicaltrials.gov, and Cochrane Databases.
Review methods
A search string was developed, and all databases queried for keywords on three subjects: head and neck cancer, lymphedema, and therapy. Results were uploaded to an EndNote database where relevant items were identified by hand-searching all titles and abstracts. Subsequently results were combined, duplicates removed, and full papers screened according to eligibility criteria.
Results
Of a total 492 search results, twenty-six items met eligibility criteria for this review. These included fourteen cohort studies, seven case reports, two randomized controlled trials, two systematic reviews, and one narrative review totaling 1018 study subjects. The manual lymph drainage group had the largest number of studies and participants, with fewer studies investigating selenium, liposuction, and lymphaticovenular anastomosis.
Conclusion
Evidence for the efficacy of all types of lymphedema therapy is limited by paucity of large randomized controlled trials. While manual lymph drainage is best studied, liposuction and surgical treatments have also been effective in a small number of patients.
Abbreviations
HNChead and neck cancerCDTcomplete decongestion therapyHNLhead and neck lymphedemaLVAlymphaticovenular anastomosisMLDmanual lymph drainage
Keywords
LymphedemaPost-operativeComplicationSubmental lymphedemaRadiation therapyChemotherapySurgical treatmentHead and neck cancerNeck dissectionOutcomeRadiation fibrosisManual lymph drainageComplete decongestion therapyLymphaticovenular anastomosis
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© 2019 Elsevier Inc. All rights reserved.
Author links open overlay panelAlbinaTykeraJoelFrancobSean T.MassacShaun C.DesaidScott G.Walenb
a
Saint Louis University School of Medicine, 1402 S Grand Blvd, St. Louis, MO 63104, United States of America
b
Saint Louis University Department of Otolaryngology, 3665 Vista Ave, St. Louis, MO 63110, United States of America
c
Washington University in Saint Louis Department of Otolaryngology, 1 Barnes-Jewish Hospital Plaza, St. Louis, MO 63110, United States of America
d
Johns Hopkins University School of Medicine, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, 601 N Caroline St, Baltimore, MD 21287, United States of America
Received 5 May 2019, Available online 30 May 2019.
Show less
https://doi.org/10.1016/j.amjoto.2019.05.024Get rights and content
Abstract
Objective
To perform the first systematic review evaluating all established treatment modalities of head and neck lymphedema resulting from head and neck cancer therapy. Since craniofacial lymphedema treatment represents unique challenges not addressed by extremity lymphedema therapies, a systematic review and evaluation of treatment modalities specific to this area is needed to guide clinical management and further research.
Data sources
Four electronic databases were searches from inception to September 2018. These included Scopus (Embase), PubMed (Medline), Clinicaltrials.gov, and Cochrane Databases.
Review methods
A search string was developed, and all databases queried for keywords on three subjects: head and neck cancer, lymphedema, and therapy. Results were uploaded to an EndNote database where relevant items were identified by hand-searching all titles and abstracts. Subsequently results were combined, duplicates removed, and full papers screened according to eligibility criteria.
Results
Of a total 492 search results, twenty-six items met eligibility criteria for this review. These included fourteen cohort studies, seven case reports, two randomized controlled trials, two systematic reviews, and one narrative review totaling 1018 study subjects. The manual lymph drainage group had the largest number of studies and participants, with fewer studies investigating selenium, liposuction, and lymphaticovenular anastomosis.
Conclusion
Evidence for the efficacy of all types of lymphedema therapy is limited by paucity of large randomized controlled trials. While manual lymph drainage is best studied, liposuction and surgical treatments have also been effective in a small number of patients.
Abbreviations
HNChead and neck cancerCDTcomplete decongestion therapyHNLhead and neck lymphedemaLVAlymphaticovenular anastomosisMLDmanual lymph drainage
Keywords
LymphedemaPost-operativeComplicationSubmental lymphedemaRadiation therapyChemotherapySurgical treatmentHead and neck cancerNeck dissectionOutcomeRadiation fibrosisManual lymph drainageComplete decongestion therapyLymphaticovenular anastomosis
View full text
© 2019 Elsevier Inc. All rights reserved.
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