Radioterapia para linfoceles y fístulas linfocutáneas refractarias: tratamiento corto con bajas dosis / Radiotherapy for refractory lymphoceles and lymphocutaneous fístulas: Short treatment with low doses

INTRODUCCIÓN: Las fístulas linfocutáneas o linfoceles (LFL) tienen una baja incidencia pero a los afectados pueden disminuirles severamente la calidad de vida. OBJETIVO: Evaluar la eficacia y toxicidad de dosis bajas antiinflamatorias de radioterapia como tratamiento definitivo de LFL refractarios. MATERIAL Y MÉTODOS: Estudiamos a todos los pacientes tratados desde 2001 hasta 2012 retrospectivamente en nuestro Servicio de Oncología Radioterápica. Nuestro esquema de tratamiento fue 7,5 Gy en 5 sesiones diarias administradas en acelerador lineal mediante electrones de diferentes energías según la profundidad de la lesión. Al final, y tras un mes del tratamiento, se estudió su eficacia y toxicidad. RESULTADOS: Se trató a 9 hombres y 4 mujeres con una mediana de edad media de 66 años (23-86). De ellos, 11 presentaban fístulas linfocutáneas y 2 linfoceles. La etiología desencadenante predominante fue una cirugía vascular (8 pacientes). Previamente, todos tuvieron tratamiento conservador: uno fue reoperado y a otro se le practicaron varios drenajes. Un total de 11 pacientes recibieron 7,5 Gy, uno recibió 9 Gy y otro 12 Gy al aumentar el tiempo total de tratamiento por conmorbilidad, pero con la misma dosis biológica equivalente. La duración del tratamiento fue 5 días naturales en 6 pacientes y 7 días naturales en 4 pacientes. De los tratamientos, 7 se realizaron con electrones de 12 MeV, 5 con electrones de 9 MeV y uno con electrones de 6 MeV. Al final de la radioterapia, 11 pacientes tenían una mejoría notable de su sintomatología. Al mes, 9 pacientes presentaban una resolución completa. No se observó en ninguno de los casos toxicidad rádica aguda. CONCLUSIONES: Este tratamiento es eficaz, seguro y rápido para esta enfermedad, aun cuando otros tratamientos fracasaron

INTRODUCTION: Lymphocutaneous fístulas and/or lymphoceles (LFL) have a low incidence, but they can affect the quality of life of the patient. AIM: To value effectiveness and toxicity of low dose radiotherapy as an anti-inflammatory curative treatment of LFL when other treatments are ineffective. MATERIALS AND METHODS: Consecutive patients treated in our department from 2001 to 2012 were retrospectively studied. Treatment schedule was 7.5 Gy in 5 daily sessions with linear acceleration electrons. Patients were reviewed at the end of treatment and one month after this. RESULTS: The study included 9 men and 4 women, with a mean age of 66 (23-86) years old. There were 11 lymphocutaneous fístulas and 2 lymphoceles. Predominant aetiology: vascular surgery (8 patients). All had conservative treatment, one was also re-operated, and another was drained before radiotherapy. The total dose received by 11 patients was 7.5 Gy, in one it was 9 Gy and in another, 12 Gy. The total treatment time extension was 5 natural days in 6 patients, and 7 days in 4. Seven patients were treated with 12MeV, 5 with 9 MeV, and 1 with 6 MeV electrons. On the day of last treatment session, LFL had decreased in 11 patients, and in 9 of them it was completely resolved at one month. No radiation toxicity was observed. CONCLUSIONS: This treatment is safe, effective and fast for this condition

[Radiotherapy : an option for refractory salivary fistulas]. / Radiatio : Therapieoption bei therapierefraktärer Speichelfistel.

A 45-year-old patient presented with refractory salivary fistula, attributed to multiple surgery and Botulinum toxin, following lateral parotidectomy. He underwent fractionated radiotherapy of the remaining parotid gland including the fistula opening (total dose of 30 Gy) at our clinic. In time, fistula secretion could be inhibited completely. Although the indication for radiotherapy for such fistulas is rare since Botulinum toxin has been in use, it should still be considered in refractory disease courses.

Lymphatic fistulas: obliteration by low-dose radiotherapy.

BACKGROUND: Lymphatic drainage from the surgical wound is an uncommon but challenging complication of surgical intervention. Protracted lymphorrhea contributes to morbidity, favors infections and results in a prolonged hospital stay. Treatment options include surgical ligation and, more conservatively, leg elevation, continuous local pressure, subatmospheric pressure dressings, and low-dose radiotherapy. This study examines the efficacy of low-dose radiotherapy. PATIENTS AND METHODS: 17 patients (19 fistulas) with lymphorrhea following vena saphena harvesting (n = 7), femoropopliteal bypass (n = 3), varicose vein surgery (n = 2), hip arthroplasty (n = 3; five fistulas), shunt surgery (n = 1), and piercing (n = 1) were referred for external radiotherapy. Depending on the depth of the fistula, orthovoltage (n = 12), electrons (4-11 MeV; n = 2) or photons (8 MV; n = 3) were used. Fractions between 0.3 Gy and 2 Gy were applied; the individual total dose depended on the success of the radiotherapy, i. e., the obliteration of the lymph fistula, and varied from 1 to 12 Gy. RESULTS: In 13 out of 17 patients complete obliteration of the fistula was achieved. Interestingly, this was achieved in nine of the ten patients irradiated with total doses of