Low-Dose Radiation Therapy is an Effective Treatment for Refractory Postoperative Chylous Ascites

A Case Report

Simon Brown, Chike O. Abana, Hytham Hammad, Audrey Brown, Joyce Mhlanga, Christina Binder, Nima Nabavizadeh, Charles Thomas, Timur Mitin, Erin Gilbert

Research output: Contribution to journalArticle

Abstract

Purpose: When lymphatic pathways are disrupted via obstruction or traumatic injury, a temporary or chronic chyle leak may result, which is defined as the presence of chyle that collects outside of the lymphatic vessels within the thoracic or abdominal cavities. For a chyle leak that is refractory to surgical repair, no good options exist. Radiation therapy (RT) can result in scarring and fibrosis of the lymphatic fistula. We report on the first clinical case in the United States with the successful use of low-dose (LD) RT in the management of refractory chylous ascites. Methods and Materials: A 74-year-old man developed significant chylous ascites after a laparoscopic Nissen fundoplication. After failure of numerous conservative and surgical interventions, he was referred for radiation medicine. We delivered a dose of 10 Gy in daily 1 Gy fractions to the para-aortic region, including the cisterna chyli and thoracic duct from T12 to L2. Results: The patient tolerated LD-RT well with no toxicity. By the time of the 8-month post-RT follow-up visit, he had decreased chylous ascite levels and required no paracentesis or peritoneovenous shunting. There was no evidence of chylous ascites or recurrent chyle leak at the time of the 18-month follow-up visit. Conclusions: LD-RT for refractory postoperative chylous ascites is a safe and reasonable option that can provide temporary relief in addition to other conservative methods. This is the first reported case of refractory chylous ascites in the United States that was successfully treated with LD-RT.

Original languageEnglish (US)
JournalPractical Radiation Oncology
DOIs
StatePublished - Jan 1 2019

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Chylous Ascites
Chyle
Radiotherapy
Thoracic Duct
Therapeutics
Thoracic Cavity
Paracentesis
Fundoplication
Lymphatic Vessels
Abdominal Cavity
Fistula
Cicatrix
Fibrosis
Medicine
Radiation
Wounds and Injuries

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Low-Dose Radiation Therapy is an Effective Treatment for Refractory Postoperative Chylous Ascites : A Case Report. / Brown, Simon; Abana, Chike O.; Hammad, Hytham; Brown, Audrey; Mhlanga, Joyce; Binder, Christina; Nabavizadeh, Nima; Thomas, Charles; Mitin, Timur; Gilbert, Erin.

In: Practical Radiation Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Brown, Simon ; Abana, Chike O. ; Hammad, Hytham ; Brown, Audrey ; Mhlanga, Joyce ; Binder, Christina ; Nabavizadeh, Nima ; Thomas, Charles ; Mitin, Timur ; Gilbert, Erin. / Low-Dose Radiation Therapy is an Effective Treatment for Refractory Postoperative Chylous Ascites : A Case Report. In: Practical Radiation Oncology. 2019.
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