Lower Extremity Lymphedema in Gynecologic Cancer Patients: Propensity Score Matching Analysis of External Beam Radiation versus Brachytherapy.
Won Ick ChangHyun-Cheol KangHong-Gyun WuHak Jae KimSeung Hyuck JeonMaria LeeHee Seung KimHyun Hoon ChungJae Weon KimNoh Hyun ParkYong Sang SongKwan-Sik SeoPublished in: Cancers (2019)
The goal of this study is to compare the risk of lower extremity lymphedema (LEL) between pelvic external beam radiation therapy (EBRT) and vaginal brachytherapy, and to identify risk factors for LEL in gynecologic cancer patients treated with adjuvant radiation therapy (RT) after radical surgery. A total of 263 stage I-III gynecologic cancer patients who underwent adjuvant RT were retrospectively reviewed. One-to-one case-matched analysis was conducted with propensity scores generated from patient, tumor, and treatment characteristics. Using the risk factors found in this study, high- and low-risk groups were identified. With a median follow-up of 36.0 months, 35 of 263 (13.3%) patients developed LEL. In multivariate analysis, laparoscopic surgery (HR 2.548; p = 0.024), harvesting more than 30 pelvic lymph nodes (HR 2.246; p = 0.028), and para-aortic lymph node dissection (PALND, HR 2.305; p = 0.014) were identified as independent risk factors for LEL. After propensity score matching, the LEL incidence of the brachytherapy group was significantly lower than the EBRT group (p = 0.025). In conclusion, high-risk patients with risk factors such as laparoscopic surgery, harvesting more than 30 pelvic lymph nodes, PALND, and adjuvant pelvic EBRT require closer observation for LEL.
Keyphrases
- radiation therapy
- lymph node
- laparoscopic surgery
- risk factors
- rectal cancer
- locally advanced
- high dose
- early stage
- end stage renal disease
- radiation induced
- chronic kidney disease
- minimally invasive
- newly diagnosed
- sentinel lymph node
- ejection fraction
- endometrial cancer
- heart failure
- prognostic factors
- pulmonary hypertension
- squamous cell carcinoma
- aortic valve
- coronary artery
- young adults
- peritoneal dialysis
- energy transfer
- robot assisted
- acute coronary syndrome
- smoking cessation
- data analysis