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Open AccessArticle

Lower Extremity Lymphedema in Gynecologic Cancer Patients: Propensity Score Matching Analysis of External Beam Radiation versus Brachytherapy

1
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul 03080, Korea
2
Cancer Research Institute, Seoul National University, Seoul 03080, Korea
3
Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul 03080, Korea
4
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea
5
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(10), 1471; https://doi.org/10.3390/cancers11101471
Received: 14 July 2019 / Revised: 21 August 2019 / Accepted: 25 September 2019 / Published: 30 September 2019
(This article belongs to the Special Issue Cancer Related Lymphedema)
The goal of this study is to compare the risk of lower extremity lymphedema (LEL) between pelvic external beam radiation therapy (EBRT) and vaginal brachytherapy, and to identify risk factors for LEL in gynecologic cancer patients treated with adjuvant radiation therapy (RT) after radical surgery. A total of 263 stage I–III gynecologic cancer patients who underwent adjuvant RT were retrospectively reviewed. One-to-one case-matched analysis was conducted with propensity scores generated from patient, tumor, and treatment characteristics. Using the risk factors found in this study, high- and low-risk groups were identified. With a median follow-up of 36.0 months, 35 of 263 (13.3%) patients developed LEL. In multivariate analysis, laparoscopic surgery (HR 2.548; p = 0.024), harvesting more than 30 pelvic lymph nodes (HR 2.246; p = 0.028), and para-aortic lymph node dissection (PALND, HR 2.305; p = 0.014) were identified as independent risk factors for LEL. After propensity score matching, the LEL incidence of the brachytherapy group was significantly lower than the EBRT group (p = 0.025). In conclusion, high-risk patients with risk factors such as laparoscopic surgery, harvesting more than 30 pelvic lymph nodes, PALND, and adjuvant pelvic EBRT require closer observation for LEL. View Full-Text
Keywords: lower extremity lymphedema (LEL); gynecologic cancer; external beam radiation therapy (EBRT); risk factor analysis lower extremity lymphedema (LEL); gynecologic cancer; external beam radiation therapy (EBRT); risk factor analysis
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Chang, W.I.; Kang, H.-C.; Wu, H.-G.; Kim, H.J.; Jeon, S.H.; Lee, M.; Kim, H.S.; Chung, H.H.; Kim, J.W.; Park, N.H.; Song, Y.S.; Seo, K.-S. Lower Extremity Lymphedema in Gynecologic Cancer Patients: Propensity Score Matching Analysis of External Beam Radiation versus Brachytherapy. Cancers 2019, 11, 1471.

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