Percutaneous fractionated radiotherapy of the groin to eliminate lymphatic fistulas after vascular surgery

European Journal of Medical Research

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 Schelzig^1,10  Waseem Garabet^1,10  Johannes Fischer^1,11  Martijn van Griensven^1,12 

[1]Antom-E Systems, Houston, TX, USA

[2]Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

[3]Department of Dermatology, Medical Faculty, Heinrich Heine University Hospital Dusseldorf, Düsseldorf, Germany

[4]Department of Diagnostic and Interventional Radiology, Medical Faculty University Hospital of Dusseldorf, Dusseldorf, Germany

[5]Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany

[6]Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Medical Faculty, Otto-Von-Guericke-Universität Magdeburg, Magdeburg, Germany

[7]Department of Radiation Oncology, LMU University of Munich, Munich, Germany

[8]Department of Radiation Oncology, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany

[9]Department of Surgery and Interdisciplinary Surgical Intensive Care Unit, University Hospital Dusseldorf, Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany

[10]Department of Vascular Surgery, Medical Faculty, Heinrich Heine University Hospital Dusseldorf, Düsseldorf, Germany

[11]Institute for Transplant Diagnostics and Cell Therapeutics, University Hospital, Leipzig, Germany

[12]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

【 图 表 】

40249_2023_1061_Article_IEq16.gif

13690_2023_1029_Article_IEq21.gif

Fig. 1

Fig. 1