Treating internal lymphoedema after head and neck radiotherapy was linked to better swallowing

Design

Retrospective cohort within a standardised care pathway

Population

110 patients with internal lymphoedema after head and neck radiotherapy

Primary outcome

Swallowing physiology and patient-reported swallowing at 15 months

Effect

EAT-10 change -3.63 vs +1.13 (P = .001); RSI -5.21 vs +2.55 (P < .001)

Lymphoedema after head and neck cancer treatment drives fibrosis and dysphagia. This retrospective review covered 110 patients in a standardised care pathway, all found to have internal lymphoedema three months after radiotherapy or chemoradiotherapy. Seventy-two completed treatment with a pneumatic compression device or manual lymphatic drainage; 38 did not.

At 15 months, treated patients had more favourable changes in DIGEST swallowing severity, safety and efficiency, and in patient-reported scores: EAT-10 improved by 3.6 points against a 1.1-point worsening, and the Reflux Symptom Index by 5.2 points against a 2.6-point worsening. Mouth opening and cancer recurrence did not differ. Associations held after adjustment.

Patients who complete lymphoedema treatment may differ from those who do not in motivation and health. Still, the direction supports building surveillance for internal lymphoedema into follow-up.

• Look for internal lymphoedema at about three months after head and neck radiotherapy.
• Treated patients had better swallowing on instrumental and patient-reported measures at 15 months.
• Mouth opening did not change differently with treatment.
• Refer to a lymphoedema therapist early rather than waiting for fibrosis.
• Track swallowing with a validated tool such as EAT-10 at follow-up visits.

Why it matters

Internal lymphoedema is easy to miss on routine review, yet it may be one of the few modifiable drivers of late dysphagia.

Don't overread it

Patients chose whether to complete treatment, so this cannot show lymphoedema therapy caused the better swallowing.

The statistics, in plain English

The differences are statistically clear and held after adjustment, but treatment was not randomised. Patients who finish a course of therapy are often healthier, which can inflate apparent benefit.

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