Department of Supportive Care Medicine, City of Hope Orange County, Irvine, California.
Rehabilitation Department, Instituto do Cancer, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
JAMA Otolaryngol Head Neck Surg. 2023 Aug 1;149(8):743-753. doi: 10.1001/jamaoto.2023.1473.
Head and neck cancer-associated lymphedema (HNCaL) affects up to 90% of survivors of head and neck cancer and is a substantial contributor to disability following head and neck cancer treatment. Despite the prevalence and morbidity associated with HNCaL, rehabilitation interventions are not well studied.
To identify and appraise the current evidence for rehabilitation interventions in HNCaL.
Five electronic databases were searched systematically from inception to January 3, 2023, for studies on HNCaL rehabilitation interventions. Study screening, data extraction, quality rating, and risk of bias assessment were performed by 2 independent reviewers.
Of 1642 citations identified, 23 studies (1.4%; n = 2147 patients) were eligible for inclusion. Six studies (26.1%) were randomized clinical trials (RCTs) and 17 (73.9%) were observational studies. Five of the 6 RCTs were published during 2020 to 2022. Most studies had fewer than 50 participants (5 of 6 RCTs; 13 of 17 observational studies). Studies were categorized by intervention type, including standard lymphedema therapy (11 studies [47.8%]) and adjunct therapy (12 studies [52.2%]). Lymphedema therapy interventions included standard complete decongestive therapy (CDT) (2 RCTs, 5 observational studies), modified CDT (3 observational studies), therapy setting (1 RCT, 2 observational studies), adherence (2 observational studies), early manual lymphatic drainage (1 RCT), and inclusion of focused exercise (1 RCT). Adjunct therapy interventions included advanced pneumatic compression devices (APCDs) (1 RCT, 5 observational studies), kinesio taping (1 RCT), photobiomodulation (1 observational study), acupuncture/moxibustion (1 observational study), and sodium selenite (1 RCT, 2 observational studies). Serious adverse events were either not found (9 [39.1%]) or not reported (14 [60.9%]). Low-quality evidence suggested the benefit of standard lymphedema therapy, particularly in the outpatient setting and with at least partial adherence. High-quality evidence was found for adjunct therapy with kinesio taping. Low-quality evidence also suggested that APCDs may be beneficial.
The results of this systematic review suggest that rehabilitation interventions for HNCaL, including standard lymphedema therapy with kinesio taping and APCDs, appear to be safe and beneficial. However, more prospective, controlled, and adequately powered studies are needed to clarify the ideal type, timing, duration, and intensity of lymphedema therapy components before treatment guidelines can be established.
标题：头颈部癌症相关淋巴水肿的康复干预措施：系统评价和荟萃分析
摘要：
头颈部癌症相关淋巴水肿（HNCaL）影响高达 90%的头颈部癌症幸存者，是头颈部癌症治疗后残疾的一个重要原因。尽管 HNCaL 的患病率和发病率很高，但康复干预措施的研究并不充分。
确定和评估 HNCaL 康复干预措施的现有证据。
系统地检索了五个电子数据库，从成立到 2023 年 1 月 3 日，以获取关于 HNCaL 康复干预措施的研究。由两名独立评审员进行研究筛选、数据提取、质量评级和偏倚风险评估。
在 1642 条引文中共确定了 23 项研究（1.4%；n=2147 例患者）符合纳入标准。6 项研究（26.1%）为随机临床试验（RCT），17 项（73.9%）为观察性研究。6 项 RCT 中有 5 项发表于 2020 年至 2022 年。大多数研究的参与者少于 50 人（6 项 RCT 中有 5 项；17 项观察性研究中有 13 项）。研究按干预类型分类，包括标准淋巴水肿治疗（11 项研究[47.8%]）和辅助治疗（12 项研究[52.2%]）。淋巴水肿治疗干预措施包括标准完整减压治疗（CDT）（2 项 RCT，5 项观察性研究）、改良 CDT（3 项观察性研究）、治疗环境（1 项 RCT，2 项观察性研究）、依从性（2 项观察性研究）、早期手动淋巴引流（1 项 RCT）和纳入集中运动（1 项 RCT）。辅助治疗干预措施包括高级气动压缩装置（APCDs）（1 项 RCT，5 项观察性研究）、肌内贴扎（1 项 RCT）、光生物调节（1 项观察性研究）、针灸/艾灸（1 项观察性研究）和亚硒酸钠（1 项 RCT，2 项观察性研究）。未发现（9[39.1%]）或未报告（14[60.9%]）严重不良事件。低质量证据表明标准淋巴水肿治疗有益，特别是在门诊环境下，且至少部分依从时。高质量证据表明肌内贴扎辅助治疗有效。低质量证据还表明，APCDs 可能有益。
本系统评价的结果表明，HNCaL 的康复干预措施，包括带肌内贴扎的标准淋巴水肿治疗和 APCDs，似乎是安全且有益的。然而，在制定治疗指南之前，还需要更多前瞻性、对照和充分有效的研究来明确淋巴水肿治疗各组成部分的理想类型、时机、持续时间和强度。
