Dados do Trabalho

Título

CASE REPORT: RADIOTHERAPY AS AN ALTERNATIVE FOR PERSISTENT CHYLOTHORAX MANAGEMENT

Apresentação do caso

A 33 years old male developed a superior vena cava syndrome caused by a mediastinal mass. A left supraclavicular lymph node enlargement biopsy showed an intermediate risk seminoma, TXNXM1, clinical-stage III, attaining bones, mediastinum, and extra-retroperitoneal lymph nodes. The patient was submitted to chemotherapy with four Etoposide + Ifosfamide + Mesna + Cisplatin (VIP) cycles, presenting a complete response to the treatment. However, after the treatment, he developed a significant pleural effusion, evidenced by Computed Tomography (CT). The liquid assessment confirmed the chylothorax diagnosis. The pathology was first treated with diet, but there was no response. Then, the patient underwent surgical treatment with thoracotomy with closed pleural drainage, evolving with persistent chylous drainage. In this setting, alternative treatment with radiotherapy was discussed with a multidisciplinary team and instituted, resulting in an important reduction in output. The patient evolved with a loculated pleural effusion as a sequela. Currently, after two years, the patient is clinically well, with no evidence of oncological disease, performing only clinical follow-up.

Discussão

A chylothorax is a rare form of pleural effusion characterized by leakage of chyle into the pleural space. When traumatic, its main cause is thoracic surgery. Non-traumatic etiologies include metastatic or primary malignancies, with lymphoma accounting for the majority in these cases. The diagnosis is confirmed by measuring the levels of liquid cholesterol and triglycerides in the pleural fluid analysis. The management of this entity consists of treating the underlying condition, conservative therapy, nutritional support and fluid drainage, and surgical procedures. Radiotherapy can be used as an alternative for its treatment; however, few studies are focusing on this specific use, with still inconclusive results.

Comentários finais

Radiotherapy can be considered as a therapeutic option for patients with refractory chylothorax who have failed treatment with diet, medication, and/or surgery. When feasible, always discuss the case in multidisciplinary meetings. The patient had a complete response to cancer treatment in the case reported, leaving no evidence of the oncologic disease. However, he evolved with chylothorax of non-oncological etiology in a short time that only responded to treatment with radiotherapy.

Palavras-chave

Radiotherapy; Chylothorax; Seminoma.