Incidence and Risk Factors of Lower-Extremity Lymphedema After Radical Surgery With or Without Adjuvant Radiotherapy in Patients With FIGO Stage I to Stage IIA Cervical Cancer
ABSTRACT This study aimed to determine the incidence and risk factors of lower-extremity lymphedema (LEL) in women who had radical surgery with or without adjuvant radiotherapy for International Federation of Gynecology and Obstetrics (FIGO) stage I to stage IIA cervical cancer.
The medical records were reviewed retrospectively on patients with histologically confirmed FIGO stage I to IIA cervical cancer. Lower-extremity lymphedema-related medical problems such as peripheral vascular disease, congestive heart failure, or chronic renal disease were excluded. A logistic regression analysis was used to examine the relationship between variable clinical characteristics and development of LEL.
We evaluated 707 patients. Of the 707 patients evaluated, we excluded 92 patients who had received radiotherapy as the initial therapy and 19 patients with LEL related to medical problems. Seventy-five patients (12.6%) developed LEL. The incidence was high in patients with adjuvant radiotherapy (odds ratio, 3.47; 95% confidence interval, 2.086-5.788; P = 0.000), with 78.7% of the patients with LEL having developed the condition within 3 years after initial treatment.
Adjuvant radiotherapy was significantly associated with development of LEL in women who had undergone radical surgery with lymphadenectomy for FIGO stage I to stage IIA cervical cancer. The possibility for the occurrence of LEL must be fully explained before treatment and patients should be provided with the appropriate preventive education. Further prospective studies are needed to confirm the incidence and risk factors for LEL.
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ABSTRACT: BACKGROUND: We performed a retrospective study to clarify the outcome of stage IB2-IIB patients with bulky cervical cancer who underwent neoadjuvant chemotherapy (NAC) followed by radical hysterectomy and adjuvant treatment. METHODS: Sixty-five patients with bulky stage IB2-IIB cervical cancer, treated at Tottori University Hospital between 2001 and 2011, were examined retrospectively. The indication for adjuvant treatment was limited to the following pathological high-risk factors: pelvic lymph node (PLN) involvement, parametrial infiltration (PI), and a compromised surgical margin. RESULTS: Fifty-one patients had squamous cell carcinoma (SCC) and 14 non-SCC. Three patients were ineligible for radical hysterectomy after NAC, and underwent concurrent chemoradiotherapy. In 62 patients who underwent radical hysterectomy, 13 had only PLN involvement and 6 only PI, and 10 had both PLN involvement and PI. In 33 patients who had no adjuvant treatment, 6 recurred, and only one underwent salvage chemotherapy. In 29 patients who underwent adjuvant treatment, 15 recurred and 11 died. Multivariate Cox proportional analysis revealed that PLN involvement was an independent prognostic factor. CONCLUSIONS: Even if the indication for adjuvant treatment is limited to only high-risk patients, about 70 % of stage IB2-IIB patients with bulky cervical cancer could be cured by NAC followed by radical hysterectomy. Additionally, about 40 % of those patients could be cured without adjuvant treatment. In contrast, the strategy for patients with PLN involvement, who account for about 35 % of stage IB2-IIB bulky cervical cancer after NAC, should be carefully reconsidered based on quality of life and cost-effectiveness.International Journal of Clinical Oncology 04/2013; DOI:10.1007/s10147-013-0559-0 · 2.17 Impact Factor
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ABSTRACT: Lower limb lymphedema (LLL) is a common condition after pelvic cancer treatment but few studies have evaluated its effect on the quality of life and its consequences on daily life activities among gynecological cancer survivors. We identified a cohort of 789 eligible women, treated with pelvic radiotherapy alone or as part of combined treatment of gynecological cancer, from 1991 to 2003 at two departments of gynecological oncology in Sweden. As a preparatory study, we conducted in-depth interviews with gynecological cancer survivors and constructed a study-specific questionnaire which we validated face-to-face. The questionnaire covered physical symptoms originating in the pelvis, demographic, psychological, and quality of life factors. In relation to the lymph system, 19 questions were asked. Six hundred sixteen (78 %) gynecological cancer survivors answered the questionnaire and participated in the study. Thirty-six percent (218/606) of the cancer survivors reported LLL. Overall quality of life was significantly lower among cancer survivors with LLL. They were also less satisfied with their sleep, more worried about recurrence of cancer, and more likely to interpret symptoms from the body as recurrence. Cancer survivors reported that LLL kept them from physical activity (45 %) and house work (29 %) and affected their ability to partake in social activities (27 %) or to meet friends (20 %). Lower limb lymphedema has a negative impact on quality of life among gynecological cancer survivors, affecting sleep and daily life activities, yet only a few seek professional help.Supportive Care in Cancer 06/2013; DOI:10.1007/s00520-013-1879-3 · 2.50 Impact Factor
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ABSTRACT: Evidence that obesity is associated with cancer incidence and mortality is compelling. By contrast, the role of obesity in cancer survival is less well understood. There is inconsistent support for the role of obesity in breast cancer survival, and evidence for other tumor sites is scant. The variability in findings may be due in part to comorbidities associated with obesity itself rather than with cancer, but it is also possible that obesity creates a physiological setting that meaningfully alters cancer treatment efficacy. In addition, the effects of obesity at diagnosis may be distinct from the effects of weight change after diagnosis. Obesity and related comorbid conditions may also increase risk for common adverse treatment effects, including breast cancer-related lymphedema, fatigue, poor health-related quality of life, and worse functional health. Racial and ethnic groups with worse cancer survival outcomes are also the groups for whom obesity and related comorbidities are more prevalent, but findings from the few studies that have addressed these complexities are inconsistent. We outline a broad theoretical framework for future research to clarify the specifics of the biological-social-environmental feedback loop for the combined and independent contributions of race, comorbid conditions, and obesity on cancer survival and adverse treatment effects. If upstream issues related to comorbidities, race, and ethnicity partly explain the purported link between obesity and cancer survival outcomes, these factors should be among those on which interventions are focused to reduce the burden of cancer.CancerSpectrum Knowledge Environment 08/2013; DOI:10.1093/jnci/djt223 · 15.16 Impact Factor