Radiation Therapy of Lymphatic Fistulae After Vascular Surgery in the Groin.

Autor:	Hautmann MG; Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany. Electronic address: matthias.hautmann@ukr.de., Dietl B; Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany., Wagner L; Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany; Public Health Department, Cologne, Germany., Zeman F; Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany., Kölbl O; Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany., Pfister K; Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany., Schierling W; Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2021 Nov 15; Vol. 111 (4), pp. 949-958. Date of Electronic Publication: 2021 Jul 27.
DOI:	10.1016/j.ijrobp.2021.07.1696
Abstrakt:	Purpose: Lymphatic fistulas are common complications after vascular surgery, especially in the groin, and can lead to a prolongation of the inpatient stay, wound infections, and follow-up operations. Radiation therapy is one of the nonsurgical treatment options; however, evidence and discussion about the ideal dosage and timing are limited. Methods and Materials: The analysis was performed on patients from a German university hospital and included 191 patients with 206 lymphatic fistulas from 2005 to 2016. Four different endpoints were analyzed. The patients were irradiated with a fraction dose of 3 Gy up to a cumulative dose of 9 Gy (94 cases) or 18 Gy (112 cases). The median age of the patients was 70.5 years; 74% were male and 26% were female. Vascular surgery included bypass grafts (52%), thromboendarterectomy/patch angioplasty (26%), and vascular access for aortic endografts (22%). Results: The response to radiation therapy for the 4 different endpoints was 88% (25% decrease in secretion volume), 80% (secretion <50 mL per 24 hours), 81% (removal of the drainage), and 75% (freedom from any intervention). The overall response for all 4 endpoints was 63% (129 of 206) after completion of radiation therapy and 34% (70 of 206) after 1 course with a total dose up to 9 Gy. The median lymphatic secretion was 150 mL per 24 hours before radiation therapy and 60 mL per 24 hours 1 day after the end of therapy. The drainage could be removed a median of 3 days after radiation therapy completion. There was no significant difference between patients starting the radiation within 5 to 9 days or ≥10 days postoperatively (P = .971; OR, 0.99; 95% confidence interval, 0.56-1.74). No relevant factors influencing the response rate could be identified. Reoperation was required in 50 of the 206 cases (25%): 24 (12%) owing to persistent lymphatic fistula and complications and 26 (13%) owing to wound and/or vascular complications. Conclusions: Radiation therapy seems to be an effective nonsurgical treatment option for reducing lymphatic secretion after vascular surgery in the groin. Starting radiation early (≤9 days) or late (≥10 days) postoperatively did not affect the success rate. (Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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