Radiotherapy of lymphatic fistulas and lymphoceles

Background: The treatment of persistent postoperative lymphatic fistulas or lymphoceles is often a problem. Approximately 2% of patients will develop lymphatic fistula after vascular surgery. This can require a long lasting c onservative therapy. If spontaneous cure fails. a second operation with wou nd revision becomes necessary. We studied low-dose percutaneous radiotherap y to be used as an alternative treatment in addition to conservative or sur gical therapy. Patients and Methods: Between 1989 and 1998 29 patients (25 with lymphatic fistulas, 4 with lymphoceles) received radiation therapy. Depending on the depth of the fistula 27 patients were treated with electrons (7 to 18 MeV). Two other patients suffering of retroperitoneal lymphoceles received a tre atment with photons (15 MV). In all patients the fractionation was 4- to 5 x 1.0 Gy/week and the dose ranged from 3 to 12 Gy depending upon the onset of the radiation therapy effect. Results: In 27 of 28 evaluable patients a complete disappearance of the fis tula or lymphocele was achieved by radiation during therapy or shortly afte rwards. In 1 case no benefit was observed after a dose of 11 Gy. This patie nt required further surgery with wound exploration. Conclusion: Low dose percutaneous radiotherapy (up to 10 to 12 Gy) is effec tive to heal lymphatic fistulas and lymphoceles without complications. Indi vidual dosage is required because doses even lower than 10 Gy may be effect ive. Radiation can be effective even after a failed conservative therapy or instead of surgery.