School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
Speech Pathology Department, Calvary Mater Newcastle, Locked Mail Bag 7, Hunter Region Mail Centre, NSW, 2310, Australia.
Dysphagia. 2023 Aug;38(4):1059-1071. doi: 10.1007/s00455-022-10526-1. Epub 2022 Oct 29.
The aim of the study was to examine the following: (a) the trajectory of external and internal head and neck lymphoedema (HNL) in patients with head and neck cancer (HNC) up to 12 months post-chemoradiotherapy (CRT) and (b) the relationship between HNL and swallowing function. Using a prospective longitudinal cohort study, external/internal HNL and swallowing were examined in 33 participants at 3, 6 and 12 months post-CRT. External HNL was assessed using the Assessment of Lymphoedema of the Head and Neck and the MD Anderson Cancer Centre Lymphoedema Rating Scale. Internal HNL was rated using Patterson's Radiotherapy Oedema Rating Scale. Swallowing was assessed via clinical, instrumental and patient-reported measures. Associations between HNL and swallowing were examined using multivariable regression models. External HNL was prevalent at 3 months (71%), improved by 6 months (58%) and largely resolved by 12 months (10%). In contrast, moderate/severe internal HNL was prevalent at 3 months (96%), 6 months (84%) and at 12 months (65%). More severe penetration/aspiration and increased diet modification were associated with higher severities of external HNL (p=0.006 and p=0.031, respectively) and internal HNL (p<0.001 and p=0.007, respectively), and more diffuse internal HNL (p=0.043 and p=0.001, respectively). Worse patient-reported swallowing outcomes were associated with a higher severity of external HNL (p=0.001) and more diffuse internal HNL (p=0.002). External HNL largely resolves by 12 months post-CRT, but internal HNL persists. Patients with a higher severity of external and/or internal HNL and those with more diffuse internal HNL can be expected to have more severe dysphagia.
（a）头颈部癌症（HNC）患者在放化疗（CRT）后 12 个月内外部和内部头颈部淋巴水肿（HNL）的轨迹；（b）HNL 与吞咽功能之间的关系。本研究采用前瞻性纵向队列研究，在 CRT 后 3、6 和 12 个月时检查 33 名参与者的外部/内部 HNL 和吞咽功能。外部 HNL 使用头颈部淋巴水肿评估量表和 MD 安德森癌症中心淋巴水肿分级量表进行评估。内部 HNL 使用 Patterson 放射治疗水肿分级量表进行评分。吞咽功能通过临床、仪器和患者报告的测量进行评估。使用多变量回归模型检验 HNL 与吞咽之间的相关性。外部 HNL 在 3 个月时（71%）普遍存在，6 个月时（58%）有所改善，12 个月时（10%）基本得到解决。相比之下，中度/重度内部 HNL 在 3 个月时（96%）、6 个月时（84%）和 12 个月时（65%）较为普遍。更严重的渗透/误吸和增加饮食调整与更高的外部 HNL 严重程度相关（p=0.006 和 p=0.031），以及更严重的内部 HNL（p<0.001 和 p=0.007）和更广泛的内部 HNL（p=0.043 和 p=0.001）。更差的患者报告的吞咽结果与更高的外部 HNL 严重程度（p=0.001）和更广泛的内部 HNL 相关（p=0.002）。外部 HNL 在 CRT 后 12 个月基本得到解决，但内部 HNL 仍存在。外部和/或内部 HNL 严重程度更高和内部 HNL 更广泛的患者预计会有更严重的吞咽困难。
