Department of Gynecologic Oncology, Tekirdag Dr Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey
Department of Physical Medicine and Rehabilitation, Tekirdag Dr Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Turkey.
Int J Gynecol Cancer. 2023 Dec 4;33(12):1928-1933. doi: 10.1136/ijgc-2023-004811.
Lower extremity lymphedema secondary to cancer treatment impacts quality of life for gynecological cancer survivors. Complex decongestive physiotherapy is applied when lymphedema is diagnosed, but prophylactic physiotherapy is not yet a standard of care. The aim of this study is to evaluate prophylactic complex physiotherapy in patients with gynecological cancer and its effects on patient-reported symptoms based on the Gynecologic Cancer Lymphedema Questionnaire.
The data of patients diagnosed with gynecological cancers who underwent lymphadenectomy from July 2021 to June 2022 was evaluated. All patients were referred to the physiotherapy unit before adjuvant treatment. Patients who accepted prophylactic physiotherapy were informed and massage and exercise training were implemented, whereas patients who declined were solely informed. Bilateral lower extremity circumferences were measured at 1, 3, 6, and 12 months at the levels of 10 cm, 30 cm, and 50 cm above the heels. A translated form of the Gynecologic Cancer Lymphedema Questionnaire was administered to all patients at the last visit.
A total of 100 patients were included in the study. Patients were diagnosed with endometrial (50%), ovarian (32%), cervical (16%), and vulvar (2%) cancer. Overall, 70% underwent systematic pelvic±para-aortic lymphadenectomy whereas sentinel lymph node mapping was performed in 30%. Lymphedema was seen in 5% (n=3) of the prophylactic physiotherapy positive group and in 60% (n=24) of the physiotherapy negative group. The median score was 3 (range 1-5) in the physiotherapy positive group and 16 (range 9-20) in the physiotherapy negative group. In patients diagnosed with lymphedema in the physiotherapy negative group, systematic lymphadenectomy was performed in 91.7% (n=22) and a higher number of lymph nodes was extracted (median 45.5; p=0.002).
Prophylactic complex physiotherapy is associated with lower rates of lymphedema and better patient-reported symptom scores according to the Gynecologic Cancer Lymphedema Questionnaire.
癌症治疗引起的下肢淋巴水肿会影响妇科癌症幸存者的生活质量。当诊断出淋巴水肿时，会应用复杂的消肿物理疗法，但预防性物理疗法尚未成为护理标准。本研究的目的是评估妇科癌症患者预防性复杂物理疗法及其对基于妇科癌症淋巴水肿问卷的患者报告症状的影响。
评估了 2021 年 7 月至 2022 年 6 月期间接受淋巴结切除术的妇科癌症患者的数据。所有患者在辅助治疗前都被转介到物理治疗科。接受预防性物理治疗的患者会被告知并进行按摩和运动训练，而拒绝接受预防性物理治疗的患者仅被告知。在脚跟上方 10cm、30cm 和 50cm 处的水平，在 1、3、6 和 12 个月时测量双侧下肢周径。在最后一次就诊时，所有患者均接受了妇科癌症淋巴水肿问卷的翻译版本。
本研究共纳入 100 例患者。患者被诊断为子宫内膜癌（50%）、卵巢癌（32%）、宫颈癌（16%）和外阴癌（2%）。总体而言，70%的患者接受了系统的盆腔±腹主动脉淋巴结切除术，而 30%的患者接受了前哨淋巴结绘图。预防性物理治疗阳性组中有 5%（n=3）出现淋巴水肿，而物理治疗阴性组中有 60%（n=24）出现淋巴水肿。物理治疗阳性组的中位数评分为 3（范围 1-5），物理治疗阴性组的中位数评分为 16（范围 9-20）。在物理治疗阴性组中诊断为淋巴水肿的患者中，91.7%（n=22）进行了系统淋巴结切除术，提取的淋巴结数量更多（中位数 45.5；p=0.002）。
根据妇科癌症淋巴水肿问卷，预防性复杂物理疗法与较低的淋巴水肿发生率和更好的患者报告症状评分相关。
