title: Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema.
abstract: 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.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. jcormier@mdanderson.org
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
authors.forename: Robert L
authors.initials: RL
authors.lastname: Askew
authors.forename: Kristi S
authors.initials: KS
authors.lastname: Mungovan
authors.forename: Yan
authors.initials: Y
authors.lastname: Xing
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Jane M
authors.initials: JM
authors.lastname: Armer
mesh_terms: D001943:Breast Neoplasms / Q000150:complications / Q000628:therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008209:Lymphedema / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D009369:Neoplasms / Q000150:complications*; D011183:Postoperative Complications; D011786:Quality Control; D012307:Risk Factors