Purpose: Head and neck lymphoedema (HNL) is prevalent following head and neck cancer (HNC) treatment, and has been associated with more severe dysphagia. However, little is known about its trajectory post-treatment and how this impacts swallowing. The aim of this prospective longitudinal cohort study was to: (1) examine the trajectory of HNL in patients with HNC treated with chemoradiotherapy (CRT); and (2) examine the association between HNL and dysphagia.
Methodology: Thirty-three patients (91% male, 91% oropharyngeal tumours) were recruited and data collected at 3, 6 and 12 months post CRT. External HNL (E-HNL) was assessed with the Assessment of Lymphoedema of the Head and Neck and the MD Anderson Cancer Centre Lymphoedema Rating Scale. Internal HNL (I-HNL) was assessed with Patterson’s Radiotherapy Oedema Rating Scale. Swallowing was assessed via instrumental, clinical and patient-reported outcome measures. Associations between HNL and swallowing were examined with multivariable regression models.
Results: E-HNL was prevalent at 3 months (71%), had begun to improve at 6 months (58%), and was largely resolved by 12 months (10%). The majority had moderate/severe I-HNL at 3 months (96%) and 6 months (84%), with some reduction at 12 months (64%). More severe penetration/aspiration and increased diet modification were associated with higher severities of E-HNL (p=0.001, 0.036, respectively) and I-HNL (p<0.001, 0.007, respectively), and more diffuse I-HNL (p =0.043, 0.001, respectively). More difficulty eating solid foods was also associated with a higher severity of E-HNL (p=0.004) and more diffuse I-HNL (p=0.002).
Conclusion: E-HNL is most prevalent at 3 months post CRT and has largely resolved by 12 months, whereas I-HNL persists. There is some reduction in I-HNL severity/diffuseness, but it did not fully resolve over 12 months. Patients who have more severe E-HNL and I-HNL or have more diffuse I-HNL may also experience more severe dysphagia.