病例报告：回顾性外科医生指导下对术后乳糜胸低剂量放疗中临床靶体积描绘的重新评估：一个8例患者的病例系列
Case Report: Retrospective surgeon-guided reassessment of clinical target volume delineation in low-dose radiotherapy for postoperative chylothorax: an eight-patient case series.
摘要(中文译文)
术后乳糜胸是胸外科手术后一种少见但处理棘手的并发症。当保守治疗或外科干预失败时，低剂量外照射放疗（RT）已被提出作为辅助治疗手段，但与治疗成功相关的因素仍不明确。我们开展了一项回顾性病例系列研究，纳入同一机构（2019年1月至2022年7月）接受RT治疗的8例持续性术后乳糜胸患者。所有患者均接受低剂量RT（9 Gy分次1.5 Gy，或10 Gy分次2 Gy）。为探讨与结局相关的因素，胸外科医生回顾性复习了手术清扫野并重新勾画临床靶区（CTV），将其与实施的RT等剂量分布进行比较。8例患者中有4例（50%）乳糜胸消退且无复发。基线乳糜引流量极高的患者（如>1,500 mL/天）尽管整体等剂量覆盖看似充分，但对RT反应有限。回顾性计划审查还显示，在若干治疗未成功的病例中，手术清扫的淋巴区域未被完全纳入RT野内。本病例系列强调了由外科医生引导的回顾性CTV重新评估在识别低剂量RT治疗术后乳糜胸时临床相关覆盖缺口方面的价值。在本系列中，高引流量（>1,500 mL/天）患者对RT反应不佳，提示对部分病例或许应更早考虑外科干预；然而，这一观察结果尚需在更大队列中验证。
Abstract
Postoperative chylothorax is an uncommon but challenging complication after thoracic surgery. Low-dose external beam radiotherapy (RT) has been proposed as an adjunct treatment when conservative management or surgical intervention fails, but factors associated with treatment success remain unclear. We conducted a retrospective case series of eight patients with persistent postoperative chylothorax treated with RT at a single institution (January 2019-July 2022). All patients received low-dose RT (9 Gy in 1.5-Gy fractions or 10 Gy in 2-Gy fractions). To explore factors associated with outcomes, thoracic surgeons retrospectively reviewed surgical dissection fields and re-contoured clinical target volumes (CTVs), which were compared with delivered RT isodose distributions. Chylothorax resolved without recurrence in 4 of 8 patients (50%). Patients with extremely high baseline chyle output (e.g., >1,500 mL/day) showed limited response to RT despite apparently adequate overall isodose coverage. Retrospective plan review also demonstrated incomplete inclusion of surgically dissected lymphatic regions within the RT field in several unsuccessful cases. This case series highlights the value of retrospective surgeon-guided CTV reassessment in identifying clinically relevant coverage gaps in postoperative chylothorax treated with low-dose RT. In this series, patients with high output (>1,500 mL/d) had poor responses to RT, suggesting that earlier surgical intervention may be warranted in selected cases; however, this observation requires validation in larger cohort.
如何引用
AMA
Mu-Chou Lin, Forn-Chia Lin, Ying-Yuan Chen. Case Report: Retrospective surgeon-guided reassessment of clinical target volume delineation in low-dose radiotherapy for postoperative chylothorax: an eight-patient case series.. Frontiers in medicine. 2026; doi:10.3389/fmed.2026.1828683.
APA
Mu-Chou Lin, Forn-Chia Lin, Ying-Yuan Chen (2026). Case Report: Retrospective surgeon-guided reassessment of clinical target volume delineation in low-dose radiotherapy for postoperative chylothorax: an eight-patient case series.. Frontiers in medicine. https://doi.org/10.3389/fmed.2026.1828683
GB/T 7714
Mu-Chou Lin, Forn-Chia Lin, Ying-Yuan Chen. Case Report: Retrospective surgeon-guided reassessment of clinical target volume delineation in low-dose radiotherapy for postoperative chylothorax: an eight-patient case series.[J]. Frontiers in medicine, 2026 doi:10.3389/fmed.2026.1828683.
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