Lymph edema of the lower extremities after lymphadenectomy and radiotherapy for cervical cancer.
OBJECTIVE
To assess the incidence of clinical lymph edema after lymphadenectomy and postoperative radiotherapy (RT).


METHODS
From 1994-2002 192 patients with risk factors for recurrence received radiotherapy with FIGO I (58.8%), II (35.4%), III (4.2%) or IV (1.6%). RT consisted of teletherapy (10.4%), brachytherapy of the vaginal vault (20.8%) or a combination of both (68.8%). Additional chemotherapy was given in 69 patients (35.9%). Surgery comprised laparoscopically assisted radical vaginal hysterectomy (LARVH) (35.4%), radical abdominal hysterectomy (RAH) (48.4%), simple hysterectomy (HE) (11.5%) or exenteration (4.7%).


RESULTS
73 patients had lymph node metastases, 119 had negative lymph nodes. In patients with LARVH 6-74 (median 30) lymph nodes were removed, with RAH 3-70 (median 21 lymph nodes), and after HE or exenteration 5-50 (median 13 lymph nodes). 90 patients had 25 or less lymph nodes removed, 83 patients more than 25 lymph nodes removed. Prognostic factors, such as age, FIGO stages, histologic grading and type of histology were well balanced in these cohorts. 45 (23.4%) of all patients developed clinically relevant lymph edema of the lower limb with a median latency of 11 (1-121) months. When 25 or less lymph nodes were removed 17.8% of patients developed leg edema, when more than 25 lymph nodes were removed 32.5% of patients were diagnosed with lymph edema (p = 0.025). Radiotherapy and chemotherapy had no influence on the incidence of leg edema. Overall survival at 5 (10) years was independent of number of lymph nodes removed.


CONCLUSIONS
The data suggest increasing rates of leg edema with increasing number of lymph nodes dissected independent of the type of radiotherapy and chemotherapy performed. The lymph node sampling policy should be planned carefully in respect to minimize the risk of leg lymph edema.
Füller
Jürgen
J
Department of Radiooncology, University Hospital, Friedrich Schiller University of Jena, Germany. Juergen.Fueller@med.uni-jena.de
Guderian
Dorothee
D
Köhler
Christhardt
C
Schneider
Achim
A
Wendt
Thomas G
TG
D000328:Adult; D003131:Combined Modality Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008207:Lymphatic Metastasis / Q000473:pathology; D008209:Lymphedema / Q000453:epidemiology*; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*