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

Danny Jazmati; Bálint Tamaskovics; Norman-Philipp Hoff; Bernhard Homey; Edwin Bölke; Belebenie Boyomo; Waseem Garabet; Jan Haussmann; Wilfried Budach; Judith Neuwahl; Hubert Schelzig; Stefanie Corradini; Martijn van Griensven; Johannes Fischer; Wolfram Trudo Knoefel; John Pegani; Alessia Pedoto; Gerald Antoch; Julian Kirchner; Tom Lüdde; Noemi F Freise; Torsten Feldt; Björn-Erik Ole Jensen; Verena Keitel; Christiane Matuschek

doi:10.1186/s40001-023-01033-6

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

Danny Jazmati, Bálint Tamaskovics, Norman-Philipp Hoff, Bernhard Homey, Edwin Bölke^*, Belebenie Boyomo, Waseem Garabet, Jan Haussmann, Wilfried Budach, Judith Neuwahl, Hubert Schelzig, Stefanie Corradini, Martijn van Griensven, Johannes Fischer, Wolfram Trudo Knoefel, John Pegani, Alessia Pedoto, Gerald Antoch, Julian Kirchner, Tom LüddeNoemi F Freise, Torsten Feldt, Björn-Erik Ole Jensen, Verena Keitel, Christiane Matuschek

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Vascular 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 METHODS: As 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.

RESULTS: Twelve 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.

CONCLUSION: Low-dose irradiation of the groin is a treatment option for persistent lymphatic fistula after inguinal vascular surgery.

Original language	English
Article number	70
Number of pages	9
Journal	European Journal of Medical Research
Volume	28
Issue number	1
DOIs	https://doi.org/10.1186/s40001-023-01033-6
Publication status	Published - 9 Feb 2023

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Jazmati, D., Tamaskovics, B., Hoff, N.-P., Homey, B., Bölke, E., Boyomo, B., Garabet, W., Haussmann, J., Budach, W., Neuwahl, J., Schelzig, H., Corradini, S., van Griensven, M., Fischer, J., Knoefel, W. T., Pegani, J., Pedoto, A., Antoch, G., Kirchner, J., ... Matuschek, C. (2023). Percutaneous fractionated radiotherapy of the groin to eliminate lymphatic fistulas after vascular surgery. European Journal of Medical Research, 28(1), Article 70. https://doi.org/10.1186/s40001-023-01033-6

@article{0f363f40e72048ab9ff4853e77eafbe4,

title = "Percutaneous fractionated radiotherapy of the groin to eliminate lymphatic fistulas after vascular surgery",

abstract = "BACKGROUND: Vascular 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 METHODS: As 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.RESULTS: Twelve 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.CONCLUSION: Low-dose irradiation of the groin is a treatment option for persistent lymphatic fistula after inguinal vascular surgery.",

author = "Danny Jazmati and B{\'a}lint Tamaskovics and Norman-Philipp Hoff and Bernhard Homey and Edwin B{\"o}lke and Belebenie Boyomo and Waseem Garabet and Jan Haussmann and Wilfried Budach and Judith Neuwahl and Hubert Schelzig and Stefanie Corradini and {van Griensven}, Martijn and Johannes Fischer and Knoefel, {Wolfram Trudo} and John Pegani and Alessia Pedoto and Gerald Antoch and Julian Kirchner and Tom L{\"u}dde and Freise, {Noemi F} and Torsten Feldt and Jensen, {Bj{\"o}rn-Erik Ole} and Verena Keitel and Christiane Matuschek",

note = "{\textcopyright} 2023. The Author(s).",

year = "2023",

month = feb,

day = "9",

doi = "10.1186/s40001-023-01033-6",

language = "English",

volume = "28",

journal = "European Journal of Medical Research",

issn = "0949-2321",

publisher = "BioMed Central",

number = "1",

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Jazmati, D, Tamaskovics, B, Hoff, N-P, Homey, B, Bölke, E, Boyomo, B, Garabet, W, Haussmann, J, Budach, W, Neuwahl, J, Schelzig, H, Corradini, S, van Griensven, M, Fischer, J, Knoefel, WT, Pegani, J, Pedoto, A, Antoch, G, Kirchner, J, Lüdde, T, Freise, NF, Feldt, T, Jensen, B-EO, Keitel, V & Matuschek, C 2023, 'Percutaneous fractionated radiotherapy of the groin to eliminate lymphatic fistulas after vascular surgery', European Journal of Medical Research, vol. 28, no. 1, 70. https://doi.org/10.1186/s40001-023-01033-6

TY - JOUR

T1 - Percutaneous fractionated radiotherapy of the groin to eliminate lymphatic fistulas after vascular surgery

AU - Jazmati, Danny

AU - Tamaskovics, Bálint

AU - Hoff, Norman-Philipp

AU - Homey, Bernhard

AU - Bölke, Edwin

AU - Boyomo, Belebenie

AU - Garabet, Waseem

AU - Haussmann, Jan

AU - Budach, Wilfried

AU - Neuwahl, Judith

AU - Schelzig, Hubert

AU - Corradini, Stefanie

AU - van Griensven, Martijn

AU - Fischer, Johannes

AU - Knoefel, Wolfram Trudo

AU - Pegani, John

AU - Pedoto, Alessia

AU - Antoch, Gerald

AU - Kirchner, Julian

AU - Lüdde, Tom

AU - Freise, Noemi F

AU - Feldt, Torsten

AU - Jensen, Björn-Erik Ole

AU - Keitel, Verena

AU - Matuschek, Christiane

PY - 2023/2/9

Y1 - 2023/2/9

N2 - BACKGROUND: Vascular 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 METHODS: As 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.RESULTS: Twelve 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.CONCLUSION: Low-dose irradiation of the groin is a treatment option for persistent lymphatic fistula after inguinal vascular surgery.

AB - BACKGROUND: Vascular 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 METHODS: As 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.RESULTS: Twelve 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.CONCLUSION: Low-dose irradiation of the groin is a treatment option for persistent lymphatic fistula after inguinal vascular surgery.

U2 - 10.1186/s40001-023-01033-6

DO - 10.1186/s40001-023-01033-6

M3 - Article

C2 - 36755343

SN - 0949-2321

VL - 28

JO - European Journal of Medical Research

JF - European Journal of Medical Research

IS - 1

M1 - 70

ER -