Lymphedema beyond breast cancer: A systematic review and meta‐analysis of cancer‐related secondary lymphedema

JN Cormier, RL Askew, KS Mungovan, Y Xing… - Cancer, 2010 - Wiley Online Library
JN Cormier, RL Askew, KS Mungovan, Y Xing, MI Ross, JM Armer
Cancer, 2010Wiley Online Library
BACKGROUND: Secondary lymphedema is a debilitating, chronic, progressive condition
that commonly occurs after the treatment of breast cancer. The purpose of the current study
was to perform a systematic review and meta‐analysis of the oncology‐related literature
excluding breast cancer to derive estimates of lymphedema incidence and to identify
potential risk factors among various malignancies. METHODS: The authors systematically
reviewed 3 major medical indices (MEDLINE, Cochrane Library databases, and Scopus) to …
BACKGROUND
Secondary lymphedema is a debilitating, chronic, progressive condition that commonly occurs after the treatment of breast cancer. The purpose of the current study was to perform a systematic review and meta‐analysis of the oncology‐related literature excluding breast cancer to derive estimates of lymphedema incidence and to identify potential risk factors among various malignancies.
METHODS
The authors systematically reviewed 3 major medical indices (MEDLINE, Cochrane Library databases, and Scopus) to identify studies (1972‐2008) that included a prospective assessment of lymphedema after cancer treatment. Studies were categorized according to malignancy, and data included treatment, complications, lymphedema measurement criteria, lymphedema incidence, and follow‐up interval. A quality assessment of individual studies was performed using established criteria for systematic reviews. Bayesian meta‐analytic techniques were applied to derive summary estimates when sufficient data were available.
RESULTS
A total of 47 studies (7779 cancer survivors) met inclusion criteria: melanoma (n = 15), gynecologic malignancies (n = 22), genitourinary cancers (n = 8), head/neck cancers (n = 1), and sarcomas (n = 1). The overall incidence of lymphedema was 15.5% and varied by malignancy (P < .001): melanoma, 16% (upper extremity, 5%; lower extremity, 28%); gynecologic, 20%; genitourinary, 10%; head/neck, 4%; and sarcoma, 30%. Increased lymphedema risk was also noted for patients undergoing pelvic dissections (22%) and radiation therapy (31%). Objective measurement methods and longer follow‐up were both associated with increased lymphedema incidence.
CONCLUSIONS
Lymphedema is a common condition affecting cancer survivors with various malignancies. The incidence of lymphedema is related to the type and extent of treatment, anatomic location, heterogeneity of assessment methods, and length of follow‐up. Cancer 2010. © 2010 American Cancer Society.
Wiley Online Library