PURPOSE
The prevalence of cancer is increasing as lifespan increases, and the incidence of gynecologic cancer is also increasing. Gynecologic cancer is treated surgically especially in advanced stages, and lymph node dissection is performed as a routine process. Additional treatment such as radiotherapy and chemotherapy are performed too. These processes cause changes in the lymphatic system, representatively lymphedema.
Some previous studies reported the benefits of complex decongestive therapy (CDT) in patients with gynecologic cancer related lymphedema. However, there are few studies about predictive factors on response to CDT as well as published descriptions of long-term predictive factors. The aim of this study is to determine the long-term (2 years) predictive factors of response to CDT in patients with gynecologic cancer related lymphedema.
METHODS
We retrospectively reviewed patients who had visited the rehabilitation medicine outpatient clinic and prescribed with CDT from March, 2011 to November, 2017. The examined factors include the following: age, BMI, marital status, side of diseased limb, type of cancer, type of surgery, removed lymph node, metastatic lymph node, type of chemotherapy, radiotherapy and the length of days from operation to the beginning of CDT. Furthermore, excess circumference ratio [(CL-CH)/CH x 100] were measured prior to treatment, at the end of CDT and 2 years after CDT. The group was divided into two groups (bandage dependent, bandage free) according to the medical record 2 years after CDT treatment.
RESULTS
A total of 139 patients were reported, 101 patients were bandage dependent(72.67%), and 38 were bandage-free (27.33%). There were significant differences in the type of season at diagnosis(in summer), days from surgery to diagnosis, cellulitis history, compliance, percentage of excess circumference at initial diagnosis between each groups(p<.05) (Table 2). In the logistic regression analysis with 2 groups, there were only significant differences in days from surgery to diagnosis, cellulitis, diagnosis season(esp. summer), percentage of excess circumference at initial diagnosis. While a suspected factor in other studies, chemotherapy or radiotherapy did not significantly affect lymphedema in this study. Also, if the PEC value is more than 10% in the initial stage, the possibility of bandage-dependency is high.
CONCLUSION
In the case of bandage-dependent lymphedema, it is important to screen early about factors affecting the edema and to perform necessary interventions.
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