A Prospective, Longitudinal and Exploratory Study of Head and Neck Lymphoedema and Dysphagia Following Chemoradiotherapy for Head and Neck Cancer.
Claire Jeans, Bena Brown, Elizabeth C Ward and 5 others
PMID 36309604WHAT IT FOUND
Head and neck lymphoedema persists in all patients one year after chemoradiotherapy, though it shifts from external to internal.
Higher severity and more widespread internal swelling are strongly linked to worse swallowing safety, diet restrictions, and patient-reported difficulty eating solids.
Key findings
01All participants had some form of head and neck lymphoedema at 3, 6, and 12 months post-treatment, but the presentation shifted: by 12 months, 90% had internal lymphoedema only, compared to 71% having both external and internal at 3 months.
02Regression analysis showed that higher severity and greater number of internal sites affected by lymphoedema were significantly associated with dysfunctional penetration-aspiration scores, worse functional oral intake, and worse clinical swallowing ability.
03Internal lymphoedema at specific sites, particularly the aryepiglottic folds, pyriform sinus, and cricopharyngeal prominence, were among the strongest predictors of swallowing difficulties and patient-reported symptom burden with solid foods.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
No baseline (pre-treatment) data was collected due to low participation, so it is unclear how much lymphoedema or dysphagia existed before treatment. The sample size was small (33 participants), and attrition was high at the 3-month mark due to patient anxiety and treatment recency, which may affect generalisability. The FEES procedure did not include volumetric control, food trials, or measures of pharyngeal residue, limiting the physiological understanding of how lymphoedema impacts swallowing. Other common side effects that influence swallowing, such as xerostomia (dry mouth) and dysgeusia (taste changes), were not measured or controlled for in the analysis. Inter-rater reliability for the internal lymphoedema rating scale was only moderate, and some individual sites had low agreement between raters.
Declared interests
The study was funded by Calvary Mater Newcastle, Hunter Cancer Research Alliance, and The University of Queensland. No specific conflicts of interest were declared by the authors.
The easy way to misread this
Do not assume that the resolution of external neck swelling means the patient is free of head and neck lymphoedema. Internal lymphoedema persisted in all patients at 12 months and is a strong predictor of ongoing swallowing difficulties, so laryngoscopy remains necessary for accurate assessment.