title: Radiotherapy in the treatment of postoperative chylothorax.
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.
authors.affiliation: Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeningerstrasse 86, 93049, Regensburg, Germany.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Sziklavari
authors.forename: Michael
authors.initials: M
authors.lastname: Allgäuer
authors.forename: Georg
authors.initials: G
authors.lastname: Hübner
authors.forename: Reiner
authors.initials: R
authors.lastname: Neu
authors.forename: Michael
authors.initials: M
authors.lastname: Ried
authors.forename: Christian
authors.initials: C
authors.lastname: Grosser
authors.forename: Tamas
authors.initials: T
authors.lastname: Szöke
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schemm
authors.forename: Hans-Stefan
authors.initials: HS
authors.lastname: Hofmann
mesh_terms: D000328:Adult; D000368:Aged; D015505:Chest Tubes; D002916:Chylothorax / Q000209:etiology / Q000532:radiotherapy* / Q000601:surgery; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000532:radiotherapy / Q000601:surgery; D012189:Retrospective Studies; D013908:Thoracotomy / Q000009:adverse effects; D016896:Treatment Outcome