Assessing head and neck cancer-related lymphoedema using indocyanine green (ICG) lymphography – a pilot study

<p dir="ltr">Purpose: This thesis investigates patient-reported outcomes, physical function, and morphological changes associated with head and neck lymphoedema (HNL). Head and neck cancer (HNC) often leads to significant functional and structural impairments in the affected area. Lymphoedema, a frequent complication of treatment, can severely impact the quality of life for affected individuals. This thesis proposes using Indocyanine Green (ICG) lymphography imaging as a potential tool to better assess lymphoedema and enhance treatment outcomes. In addition, the thesis explores the role of body composition, particularly lean body mass (LBM), in HNC outcomes, as malnutrition and altered body composition can significantly influence recovery and overall health.</p><p dir="ltr">Systematic Review: A systematic review of studies up until 9th September 2023 was completed highlighting the substantial prevalence of HNL among individuals undergoing treatment for HNC. Internal lymphoedema was consistently reported to be more prevalent than external lymphoedema for studies which distinguished between the two. There was a lack of uniformity in assessment tools which poses challenges in comparing findings across studies and establishing a standardised approach to HNL assessment. Despite this, the impact of HNL on quality of life (QoL) and physical function emerged as a significant theme in the reviewed literature. The variability in study designs, participant characteristics, and assessment methods limits the generalisability of findings, and the absence of longitudinal studies hinders understanding of HNL’s long-term effects. There is a need for tailored interventions addressing both physical and psychosocial aspects of HNL to improve individual care and overall QoL.</p><p dir="ltr">Pilot Study: A prospective pilot study was conducted to compare individuals with HNL to healthy controls, focusing on common morphological changes in lymphatic drainage patterns using ICG lymphography. The study also assessed physical, functional, and quality of life outcomes in individuals with HNL versus healthy controls. HNL can affect external areas such as the face, submental region, and neck, as well as internal lymphatic regions including the oral cavity, larynx, and pharynx. This condition impacts essential physical functions like breathing, chewing, and swallowing. It also affects psychological well-being, quality of life, and imposes significant financial burdens. The variability in standard assessment methods for visualising, objectively assessing, and staging HNL has resulted in inconsistent diagnoses and clinical management. ICG lymphography shows promise in detecting and managing HNL, indicating the need for comprehensive and standardised assessment methods.</p><p dir="ltr">Implications:</p><p dir="ltr">Treatment-related complications following HNC increase the risk of developing lymphoedema, which can diminish quality of life and affect physical, functional, and social outcomes. Enhancing our understanding of compensatory mechanisms resulting from head and neck treatment may improve individual outcomes and overall QoL.</p>