title: The risk of lymphedema after postoperative radiation therapy in endometrial cancer.
abstract: OBJECTIVE
  Lower extremity lymphedema adversely affects quality of life by causing discomfort, impaired mobility and increased risk of infection. The goal of this study is to investigate factors that influence the likelihood of lymphedema in patients with endometrial cancer who undergo adjuvant radiation with or without chemotherapy.
  
  
  METHODS
  A retrospective chart review identified all stage I-III endometrial cancer patients who had a hysterectomy with or without complete staging lymphadenectomy and adjuvant radiation therapy between January 2006 and February 2013. Patients with new-onset lymphedema after treatment were identified. Logistic regression was used to find factors that influenced lymphedema risk.
  
  
  RESULTS
  Of 212 patients who met inclusion criteria, 15 patients (7.1%) developed new-onset lymphedema. Lymphedema was associated with lymph-node dissection (odds ratio [OR], 5.6; 95% CI, 1.01 to 105.5; p=0.048) and with the presence of pathologically positive lymph nodes (OR, 4.1; 95% CI, 1.4 to 12.3; p=0.01). Multivariate logistic regression confirmed the association with lymph-node positivity (OR, 3.2; 95% CI, 1.0007 to 10.7; p=0.0499) when controlled for lymph-node dissection. Median time to lymphedema onset was 8 months (range, 1 to 58 months) with resolution or improvement in eight patients (53.3%) after a median of 10 months.
  
  
  CONCLUSIONS
  Lymph-node positivity was associated with an increased risk of lymphedema in endometrial cancer patients who received adjuvant radiation. Future studies are needed to explore whether node-positive patients may benefit from early lymphedema-controlling interventions.
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA, USA. dmitra1@partners.org.
authors.forename: Devarati
authors.identifier: http://orcid.org/0000-0002-2225-164X
authors.initials: D
authors.lastname: Mitra
authors.affiliation: Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.|Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Catalano
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Cimbak
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Antonio L
authors.identifier: http://orcid.org/0000-0002-6558-812X
authors.initials: AL
authors.lastname: Damato
authors.affiliation: Department of Gynecologic Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Muto
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision / Q000009:adverse effects; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology* / Q000628:therapy; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Endometrial Neoplasms; Lymphedema; Positive Lymph Nodes