The development of HNL has historically been attributed to surgical treatments, including the removal of lymphatic structures, vessels and nodes. Up to 90% of patients with HNC may be affected by some form of HNL which can develop externally on the soft tissues of the face and neck, internally within the oral cavity, pharynx or larynx, or as a combination of both. Head and neck lymphoedema (HNL) is highly prevalent following HNC treatment and develops when lymph fails to drain through the lymphatic vessels and/or when the lymphatic load exceeds the transport capacity of the lymphatic system. However, despite better management of disease, those treated with CRT continue to experience significant acute and chronic side effects, which can be both functionally and psychologically debilitating for those in the survivorship phase of care. The addition of concurrent chemotherapy, along with enhanced radiotherapy delivery techniques and tumour-related factors have led to improved tumour response and survival rates in patients with HNC. The use of chemoradiotherapy (CRT) treatment regimens have become increasingly used in the treatment of patients with locally advanced head and neck cancer (HNC). Patients with a higher severity of external and/or internal HNL and those with more diffuse internal HNL can be expected to have more severe dysphagia. External HNL largely resolves by 12 months post-CRT, but internal HNL persists. Worse patient-reported swallowing outcomes were associated with a higher severity of external HNL ( p=0.001) and more diffuse internal HNL ( p=0.002). More severe penetration/aspiration and increased diet modification were associated with higher severities of external HNL ( p=0.006 and p=0.031, respectively) and internal HNL ( p<0.001 and p=0.007, respectively), and more diffuse internal HNL ( p=0.043 and p=0.001, respectively). In contrast, moderate/severe internal HNL was prevalent at 3 months (96%), 6 months (84%) and at 12 months (65%). External HNL was prevalent at 3 months (71%), improved by 6 months (58%) and largely resolved by 12 months (10%). Associations between HNL and swallowing were examined using multivariable regression models. Swallowing was assessed via clinical, instrumental and patient-reported measures. Internal HNL was rated using Patterson’s Radiotherapy Oedema Rating Scale. External HNL was assessed using the Assessment of Lymphoedema of the Head and Neck and the MD Anderson Cancer Centre Lymphoedema Rating Scale. Using a prospective longitudinal cohort study, external/internal HNL and swallowing were examined in 33 participants at 3, 6 and 12 months post-CRT. The aim of the study was to examine the following: (a) the trajectory of external and internal head and neck lymphoedema (HNL) in patients with head and neck cancer (HNC) up to 12 months post-chemoradiotherapy (CRT) and (b) the relationship between HNL and swallowing function.
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