European Journal of Medical Research | |
Percutaneous fractionated radiotherapy of the groin to eliminate lymphatic fistulas after vascular surgery | |
Research | |
John Pegani1  Alessia Pedoto2  Norman-Philipp Hoff3  Bernhard Homey3  Julian Kirchner4  Gerald Antoch4  Björn-Erik Ole Jensen5  Tom Lüdde5  Torsten Feldt5  Noemi F. Freise5  Verena Keitel6  Stefanie Corradini7  Christiane Matuschek8  Judith Neuwahl8  Wilfried Budach8  Bálint Tamaskovics8  Belebenie Boyomo8  Danny Jazmati8  Jan Haussmann8  Edwin Bölke8  Wolfram Trudo Knoefel9  Hubert Schelzig1,10  Waseem Garabet1,10  Johannes Fischer1,11  Martijn van Griensven1,12  | |
[1] Antom-E Systems, Houston, TX, USA;Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA;Department of Dermatology, Medical Faculty, Heinrich Heine University Hospital Dusseldorf, Düsseldorf, Germany;Department of Diagnostic and Interventional Radiology, Medical Faculty University Hospital of Dusseldorf, Dusseldorf, Germany;Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany;Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Medical Faculty, Otto-Von-Guericke-Universität Magdeburg, Magdeburg, Germany;Department of Radiation Oncology, LMU University of Munich, Munich, Germany;Department of Radiation Oncology, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany;Department of Surgery and Interdisciplinary Surgical Intensive Care Unit, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany;Department of Vascular Surgery, Medical Faculty, Heinrich Heine University Hospital Dusseldorf, Düsseldorf, Germany;Institute for Transplant Diagnostics and Cell Therapeutics, University Hospital, Leipzig, Germany;MERLN Institute for Technology-Inspired Regenerative Medicine, Department cBITE, Maastricht University, Maastricht, The Netherlands; | |
关键词: Surgery; Wound healing; Radiation therapy; Side effects; Benign disease; Amputation; | |
DOI : 10.1186/s40001-023-01033-6 | |
received in 2022-08-10, accepted in 2023-01-26, 发布年份 2023 | |
来源: Springer | |
【 摘 要 】
BackgroundVascular surgery of the inguinal area can be complicated by persistent lymphatic fistulas. Rapid and effective treatment is essential to prevent infection, sepsis, bleeding, and possible leg amputation. Current data on irradiation of lymphatic fistulas lack recommendation on the appropriate individual and total dose, the time of irradiation, and the target volume. Presumably, a dose of 0.3–0.5 to 1–12 Gy should be sufficient for the purpose. Currently, radiotherapy is a “can” recommendation, with a level 4 low evidence and a grade C recommendation, according to the DEGRO S2 guidelines. As part of a pilot study, we analyzed the impact and limitations of low-dose radiation therapy in the treatment of inguinal lymphatic fistulas.Patients and methodsAs a part of an internal quality control project, patients with lymphatic fistulas irradiated in the groin area after vascular surgery for arterial occlusive disease (AOD) III-IV, repair of pseudo aneurysm or lymph node dissection due to melanoma were selected, and an exploratory analysis on retrospectively collected data performed.ResultsTwelve patients (10 males and 2 females) aged 62.83 ± 12.14 years underwent open vascular reconstruction for stage II (n = 2), III (n = 1), and IV (n = 7) arterial occlusive disease (AOD), lymph node dissection for melanoma (n = 1) or repair of a pseudoaneurysm (n = 1). Surgical vascular access was obtained through the groin and was associated with a persistent lymphatic fistula, secreting more than 50 ml/day. Patients were irradiated five times a week up to a maximum of 10 fractions for the duration of the radiation period. Fraction of 0.4 Gy was applied in the first 7 cases, while 5 patients were treated with a de-escalating dose of 0.3 Gy. There was a resolution of the lymphatic fistula in every patient without higher grade complications.ConclusionLow-dose irradiation of the groin is a treatment option for persistent lymphatic fistula after inguinal vascular surgery.
【 授权许可】
CC BY
© The Author(s) 2023
【 预 览 】
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