Jay W Carlson1, James Kauderer2, Alan Hutson3, Jeanne Carter4, Jane Armer5, Suzy Lockwood6, Susan Nolte7, Bob R Stewart8, Lari Wenzel9, Joan Walker10, Aimee Fleury11, Albert Bonebrake12, John Soper13, Cara Mathews14, Oliver Zivanovic15, Wm Edward Richards16, Annie Tan17, David S Alberts18, Richard R Barakat19. 1. Cancer Research for the Ozarks, 1235 E. Cherokee, Springfield, MO, 65804, USA. Electronic address: jay.carlson@mercy.net. 2. NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Elm & Carlton Sts., Buffalo, NY, 14263, USA. Electronic address: jkauderer@gogstats.org. 3. NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Elm & Carlton Sts., Buffalo, NY, 14263, USA. Electronic address: Alan.Hutson@RoswellPark.org. 4. Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA. Electronic address: carterj@mskcc.org. 5. Sinclair School of Nursing, DC 116.05, Mizzou North Suite 415, 115 Business Loop 70 West, Columbia, MO, 65010, USA. Electronic address: Armer@missouri.edu. 6. Texas Christian University, Harris College of Nursing & Health Sciences, TCU Box 298620, Ft Worth, TX, 76129, USA. Electronic address: S.lockwood@tcu.edu. 7. Abington Memorial Hospital, 1200 Old York Road, Abington, PA, 19001, USA. Electronic address: Susanannnolte@gmail.com. 8. Sinclair School of Nursing, DC 116.05, Mizzou North Suite 415, 115 Business Loop 70 West, Columbia, MO, 65010, USA. Electronic address: StewartB@missouri.edu. 9. Program in Public Health, University of California, Irvine, Irvine, CA, USA; Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA. Electronic address: lwenzel@uci.edu. 10. Stephenson Cancer Center, OUHSC, Oklahoma City, OK, 73104, USA. Electronic address: Joan-walker@ouhsc.edu. 11. Women's Cancer Center of Nevada, 3131 la Canada St. Ste 241, Las Vegas, NV, 89169, USA. Electronic address: afleury@wccenter.com. 12. Cancer Research for the Ozarks-Cox Health. Ferrell Duncan Clinic GYN-ONC, Springfield, MO, 65807, USA. Electronic address: albert.bonebrake@coxhealth.com. 13. B110 Physicians' Office BLDG, 170 Manning Drive, UNC School of Medicine, Chapel Hill, NC, 27599, USA. Electronic address: jsoper@med.unc.edu. 14. Division of Gynecologic Oncology, Women & Infants Hospital of Rhode Island, Alpert School of Medicine at Brown University, 101 Dudley St., Providence, RI, 02905, USA. Electronic address: CMathews@Wihri.org. 15. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. Electronic address: zivanovo@mskcc.org. 16. Director of Gynecologic Oncology and Surgical Specialists, St. Joseph's/Candler Health System, 225 Candler Dr., Savannah, GA, 31405, USA. Electronic address: drrichards@sjchs.org. 17. Minnesota Oncology, 11850 Blackfoot Street, NW, Suite 100, Coon Rapids MN 55433, USA. Electronic address: annie.tan@usoncology.com. 18. Department of Medicine, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA. Electronic address: DAlberts@uacc.arizona.edu. 19. Northwell Health Cancer Institute, 1111 Marcus Avenue, New Hyde Park, NY, 11042, USA. Electronic address: rbarakat@northwell.edu.
Abstract
OBJECTIVES: To evaluate the incidence and risk factors for lymphedema associated with surgery for gynecologic malignancies on GOG study 244. METHODS: Women undergoing a lymph node dissection for endometrial, cervical, or vulvar cancer were eligible for enrollment. Leg volume was calculated from measurements at 10-cm intervals starting 10 cm above the bottom of the heel to the inguinal crease. Measurements were obtained preoperatively and postoperatively at 4-6 weeks, and at 3-, 6-, 9-, 12-, 18-, and 24- months. Lymphedema was defined as a limb volume change (LVC) ≥10% from baseline and categorized as mild: 10-19% LVC; moderate: 20-40% LVC; or severe: >40% LVC. Risk factors associated with lymphedema were also analyzed. RESULTS: Of 1054 women enrolled on study, 140 were inevaluable due to inadequate measurements or eligibility criteria. This left 734 endometrial, 138 cervical, and 42 vulvar patients evaluable for LVC assessment. Median age was 61 years (range, 28-91) in the endometrial, 44 years (range, 25-83) in the cervical, and 58 years (range, 35-88) in the vulvar group. The incidence of LVC ≥10% was 34% (n = 247), 35% (n = 48), and 43% (n = 18), respectively. The peak incidence of lymphedema was at the 4-6 week assessment. Logistic regression analysis showed a decreased risk with advanced age (p = 0.0467). An exploratory analysis in the endometrial cohort showed an increased risk with a node count >8 (p = 0.033). CONCLUSIONS: For a gynecologic cancer, LVC decreased with age greater than 65, but increased with a lymph node count greater than 8 in the endometrial cohort. There was no association with radiation or other risk factors.
OBJECTIVES: To evaluate the incidence and risk factors for lymphedema associated with surgery for gynecologic malignancies on GOG study 244. METHODS:Women undergoing a lymph node dissection for endometrial, cervical, or vulvar cancer were eligible for enrollment. Leg volume was calculated from measurements at 10-cm intervals starting 10 cm above the bottom of the heel to the inguinal crease. Measurements were obtained preoperatively and postoperatively at 4-6 weeks, and at 3-, 6-, 9-, 12-, 18-, and 24- months. Lymphedema was defined as a limb volume change (LVC) ≥10% from baseline and categorized as mild: 10-19% LVC; moderate: 20-40% LVC; or severe: >40% LVC. Risk factors associated with lymphedema were also analyzed. RESULTS: Of 1054 women enrolled on study, 140 were inevaluable due to inadequate measurements or eligibility criteria. This left 734 endometrial, 138 cervical, and 42 vulvar patients evaluable for LVC assessment. Median age was 61 years (range, 28-91) in the endometrial, 44 years (range, 25-83) in the cervical, and 58 years (range, 35-88) in the vulvar group. The incidence of LVC ≥10% was 34% (n = 247), 35% (n = 48), and 43% (n = 18), respectively. The peak incidence of lymphedema was at the 4-6 week assessment. Logistic regression analysis showed a decreased risk with advanced age (p = 0.0467). An exploratory analysis in the endometrial cohort showed an increased risk with a node count >8 (p = 0.033). CONCLUSIONS: For a gynecologic cancer, LVC decreased with age greater than 65, but increased with a lymph node count greater than 8 in the endometrial cohort. There was no association with radiation or other risk factors.
Authors: Jeanne Carter; Nadeem R Abu-Rustum; Sally Saban; Ling Y Chen; Andrew J Vickers; Amy L Tin; Gabriela Billanti; Nicole A Connors; Vance Broach; Carol L Brown; Dennis S Chi; Ginger J Gardner; Deborah J Goldfrank; Elizabeth L Jewell; Mario M Leitao; Kara C Long Roche; Jennifer J Mueller; Yukio Sonoda; Oliver Zivanovic Journal: JCO Clin Cancer Inform Date: 2022-02
Authors: Maaike H M Oonk; Brian Slomovitz; Peter J W Baldwin; Helena C van Doorn; Jacobus van der Velden; Joanne A de Hullu; Katja N Gaarenstroom; Brigitte F M Slangen; Ignace Vergote; Mats Brännström; Eleonora B L van Dorst; Willemien J van Driel; Ralph H Hermans; David Nunns; Martin Widschwendter; David Nugent; Cathrine M Holland; Aarti Sharma; Paul A DiSilvestro; Robert Mannel; Dorry Boll; David Cibula; Al Covens; Diane Provencher; Ingo B Runnebaum; David Luesley; Patricia Ellis; Timothy J Duncan; Ming Y Tjiong; Derek J Cruickshank; Preben Kjølhede; Charles F Levenback; Jiri Bouda; Katharina E Kieser; Connie Palle; Nicola M Spirtos; David M O'Malley; Mario M Leitao; Melissa A Geller; Kalyan Dhar; Viren Asher; Karl Tamussino; Daniel H Tobias; Christer Borgfeldt; Jayanthi S Lea; Jo Bailey; Margareta Lood; Brynhildur Eyjolfsdottir; Stephen Attard-Montalto; Krishnansu S Tewari; Ranjit Manchanda; Pernille T Jensen; Par Persson; Linda Van Le; Hein Putter; Geertruida H de Bock; Bradley J Monk; Carien L Creutzberg; Ate G J van der Zee Journal: J Clin Oncol Date: 2021-08-25 Impact factor: 50.717
Authors: Xiaochen Zhang; Eric M McLaughlin; Jessica L Krok-Schoen; Michelle Naughton; Brittany M Bernardo; Andrea Cheville; Matthew Allison; Marcia Stefanick; Jennifer W Bea; Electra D Paskett Journal: JAMA Netw Open Date: 2022-03-01
Authors: Stefano Restaino; Nicolò Bizzarri; Vincenzo Tarantino; Silvia Pelligra; Rossana Moroni; Emilia Palmieri; Giorgia Monterossi; Barbara Costantini; Giovanni Scambia; Francesco Fanfani Journal: Int J Environ Res Public Health Date: 2022-06-16 Impact factor: 4.614
Authors: Stefan Carlsson; Matteo Bottai; Anna Lantz; Anders Bjartell; Jonas Hugosson; Gunnar Steineck; Johan Stranne; Peter Wiklund; Eva Haglind; Olof Akre Journal: BJU Int Date: 2022-03-02 Impact factor: 5.969
Authors: Sandra Russo; Joan L Walker; Jay W Carlson; Jeanne Carter; Leigh C Ward; Allan Covens; Edward J Tanner; Jane M Armer; Sheila Ridner; Sandi Hayes; Alphonse G Taghian; Cheryl Brunelle; Micael Lopez-Acevedo; Brittany A Davidson; Mark V Schaverien; Sharad A Ghamande; Michael Bernas; Andrea L Cheville; Kathleen J Yost; Kathryn Schmitz; Barbara Coyle; Jeannette Zucker; Danielle Enserro; Stephanie Pugh; Electra D Paskett; Leslie Ford; Worta McCaskill-Stevens Journal: Gynecol Oncol Date: 2020-11-04 Impact factor: 5.482