Abstract
Background/purpose
To evaluate the pattern of manifestation and risk factors for lower limb edema (LLE)
within the prospective, observational, multi-center EMBRACE study on radiochemotherapy
and MRI-guided brachytherapy in locally advanced cervical cancer (LACC).
Material/methods
LLE was prospectively assessed according to the physician-reported CTCAE v.3 and patient-reported
EORTC QLQ-CX24 questionnaire at baseline and regular follow-up.
Results
In total, 1176 patients were evaluated with a median follow-up of 27 months. Actuarial
analyses revealed 3/5-year estimates of 27%/31% of CTCAE G ≥ 1, 6.1%/6.6% of G ≥ 2
and 0.5%/0.5% for G ≥ 3.
Prevalence rates for G ≥ 1 LLE at 3 months, 1, 3 and 5 years after end of treatment
were 7%, 12%, 12%, 15% for physician-assessed and 25%, 30%, 30%, 34% for any patient-reported
symptoms and showed a steady increase over time.
Invasive lymph node staging and obesity at diagnosis are independent significant risk
factors for G ≥ 1 LLE, whereas nodal boost has no impact. Extended radiation fields
including para-aortic and/or inguinal nodes show a tendency to increase the risk.
Conclusion
Severe LLE after definitive radiochemotherapy in LACC is rare. However, the risk for
mild LLE is considerable, and related to patient-, diagnostic- and treatment characteristics.
Less invasive diagnostic surgical procedures or non-invasive assessment, less invasive
radiotherapy management and active rehabilitation are important pathways for future
developments.
Keywords
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Article info
Publication history
Published online: April 06, 2018
Accepted:
March 23,
2018
Received in revised form:
March 22,
2018
Received:
January 31,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
