头颈癌相关淋巴水肿早期治疗后的吞咽结局

文献信息

中文摘要

目的： 头颈癌相关淋巴水肿（HNCRL）是头颈癌（HNC）治疗常见且慢性的后果，可导致进行性纤维化、功能损害和生活质量下降。尽管提倡早期干预，但其与纵向吞咽结局的关联仍知之甚少。本研究评估早期HNCRL治疗是否与放疗（RT）和/或放化疗（CRT）后客观及患者报告的吞咽结局改善相关。
方法： 回顾性审查了纳入标准化HNC诊疗路径的110例患者的病历。所有参与者在RT/CRT后3个月时均发现内部HNCRL，当时建议进行淋巴水肿治疗。72例患者完成了先进气动压缩装置（APCD）或手动淋巴引流（MLD）治疗，而38例未接受治疗。在基线、RT/CRT后3个月和15个月时评估吞咽生理、患者报告结局和最大张口度（MIO）。进行了纵向组内和组间比较。
结果： 接受治疗的患者在DIGEST总体严重程度、吞咽安全性和吞咽效率方面表现出显著更有利的纵向结局（均p < 0.001），EAT-10改善更大（-3.63 vs. +1.13，p = 0.001），RSI改善更大（-5.21 vs. +2.55，p < 0.001），而MIO变化（p = 0.259）或癌症复发无显著差异。多变量调整后，DIGEST、EAT-10和RSI的关联仍然显著。
结论： 早期HNCRL治疗与吞咽生理和患者报告吞咽结局的更大改善相关。这些发现支持在多学科HNC诊疗路径中常规进行HNCRL监测和及时干预。

英文摘要

OBJECTIVE(S): Head and neck cancer-related lymphedema (HNCRL) is a common, chronic consequence of head and neck cancer (HNC) treatment that contributes to progressive fibrosis, functional impairment, and reduced quality of life. Although early intervention is advocated, its association with longitudinal swallow outcomes remains poorly understood. This study evaluated whether early HNCRL treatment was associated with improved objective and patient-reported swallowing outcomes following radiation treatment (RT) and/or chemoradiation (CRT).
METHODS: Medical records from 110 patients enrolled in a standardized HNC care pathway were retrospectively reviewed. Internal HNCRL was identified in all participants at 3-months post-RT/CRT, when lymphedema treatment was recommended. Seventy-two patients completed treatment with an advanced pneumatic compression device (APCD) or manual lymphatic drainage (MLD), while 38 did not. Swallowing physiology, patient-reported outcomes, and maximum interincisal opening (MIO) were evaluated at baseline, 3-months, and 15-months post-RT/CRT. Longitudinal within- and between-group comparisons were performed.
RESULTS: Treated patients demonstrated significantly more favorable longitudinal DIGEST outcomes for overall severity, swallowing safety, and swallowing efficiency (all p < 0.001), greater improvement in EAT-10 (-3.63 vs. +1.13, p = 0.001) and RSI (-5.21 vs. +2.55, p < 0.001), and no significant difference in MIO change (p = 0.259) or cancer recurrence. Associations for DIGEST, EAT-10, and RSI remained significant after multivariable adjustment.
CONCLUSIONS: Early HNCRL treatment was associated with greater improvements in swallowing physiology and patient-reported swallowing outcomes. These findings support routine HNCRL surveillance and timely intervention within multidisciplinary HNC care pathways.