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Open Access Research article

Radiotherapy in the treatment of postoperative chylothorax

Zsolt Sziklavari1, Michael Allgäuer2, Georg Hübner2, Reiner Neu3, Michael Ried3, Christian Grosser1, Tamas Szöke1, Rudolf Schemm1 and Hans-Stefan Hofmann13*

Author Affiliations

1 Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeningerstraße 86, 93049, Regensburg, Germany

2 Department of Radiotherapy, Hospital Barmherzige Brüder Regensburg, Prüfeningerstraße 86, 93049, Regensburg, Germany

3 Department of Thoracic Surgery, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany

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Journal of Cardiothoracic Surgery 2013, 8:72  doi:10.1186/1749-8090-8-72

Published: 8 April 2013

Abstract

Background

Chylothorax is characterized by the presence of chyle in the pleural cavity. The healing rate of non-operative treatment varies enormously; the maximum success rate in series is 70%. We investigate the efficacy and outcomes of radiotherapy for postoperative chylothorax.

Methods

Chylothorax was identified based on the quantity and quality of the drainage fluid. Radiation was indicated if the daily chyle flow exceeded 450 ml after complete cessation of oral intake. Radiotherapy consisted of opposed isocentric portals to the mediastinum using 15 MV photon beams from a linear accelerator, a single dose of 1–1.5 Gy, and a maximum of five fractions per week. The radiation target area was the anatomical region between TH3 and TH10 depending on the localization of the resected lobe. The mean doses of the ionizing energy was 8.5 Gy ± 3.5 Gy.

Results

The median start date of the radiation was the fourth day after chylothorax diagnosis. The patients’ mediastinum was radiated an average of six times. Radiotherapy, in combination with dietary restrictions, was successful in all patients. The median time between the end of the radiation and the removal of the chest tube was one day. One patient underwent wound healing by secondary intention. The median time between the end of radiation and discharge was three days, and the overall hospital stay between the chylothorax diagnosis and discharge was 18 days (range: 11–30 days). After a follow-up of six months, no patient experienced chylothorax recurrence.

Conclusions

Our results suggest that radiotherapy in combination with dietary restriction in the treatment of postoperative chylothorax is very safe, rapid and successful. This novel interventional procedure can obviate repeat major thoracic surgery and shorten hospital stays and could be the first choice in the treatment of postthoracotomy chylothorax.

Keywords:
Chylothorax; Radiotherapy; Postoperative complication