Assessing head and neck cancer-related lymphoedema using indocyanine green lymphography: a pilot study

Background: Head and neck cancer treatments can cause head and neck lymphoedema (HNL), impacting quality of life (QoL). This study examined lymphatic drainage changes in HNL using Indocyanine Green Lymphography (ICG-L) and assessed QoL, physical, and functional outcomes. Methods: Twenty individuals with HNL and 10 healthy controls completed the Lymphedema Symptom Intensity and Distress survey, bioimpedance spectroscopy (BIS), skin assessments, percent water content, and ICG-L. Analysis included non-parametric and Kruskal-Wallis tests. Results: ICG-L showed preserved original lymphatic drainage in non-surgical and unilaterally treated individuals, while bilateral treatment disrupted original pathways, prompting compensatory drainage. Individuals with HNL reported significantly higher scores in soft tissue sensation, neurological symptoms, and biobehavioral symptoms (p < 0.001). Skin assessments revealed swelling and fibrosis. Significant differences were observed in lymphatic dysfunction (p = 0.002), BIS-derived skeletal muscle mass percent (p = 0.015), and phase angle (p = 0.002). Conclusions: This study highlights the symptom burden and altered lymphatic drainage in HNL, with ICG-L showing potential for refining management strategies.