{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T05:08:48Z","timestamp":1780376928748,"version":"3.54.1"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective case series of eight patients with persistent postoperative chylothorax treated with RT at a single institution (January 2019\u2013July 2022). All patients received low-dose RT (9\u202fGy in 1.5-Gy fractions or 10\u202fGy 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Chylothorax resolved without recurrence in 4 of 8 patients (50%). Patients with extremely high baseline chyle output (e.g., &amp;gt;1,500\u202fmL\/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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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 (&amp;gt;1,500\u202fmL\/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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1828683","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T04:28:05Z","timestamp":1780374485000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Retrospective surgeon-guided reassessment of clinical target volume delineation in low-dose radiotherapy for postoperative chylothorax: an eight-patient case series"],"prefix":"10.3389","volume":"13","author":[{"given":"Mu-Chou","family":"Lin","sequence":"first","affiliation":[{"name":"Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Forn-Chia","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-Yuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University","place":["Tainan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.rmed.2009.08.010","article-title":"Chylothorax: aetiology, diagnosis and therapeutic options","volume":"104","author":"McGrath","year":"2010","journal-title":"Respir Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1016\/j.ejcts.2007.04.024","article-title":"Aetiology and management of chylothorax in adults","volume":"32","author":"Nair","year":"2007","journal-title":"Eur J Cardiothorac Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/j.athoracsur.2017.07.021","article-title":"Treatment of postsurgical Chylothorax","volume":"105","author":"Reisenauer","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1007\/s00066-014-0805-z","article-title":"Successful radiation treatment of chylous ascites following pancreaticoduodenectomy","volume":"191","author":"Corradini","year":"2015","journal-title":"Strahlenther Onkol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"380","DOI":"10.3857\/roj.2017.00178","article-title":"Low-dose 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Surg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2482","DOI":"10.1007\/s00330-015-4112-6","article-title":"The thoracic duct: clinical importance, anatomic variation, imaging, and embolization","volume":"26","author":"Johnson","year":"2016","journal-title":"Eur Radiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1016\/S0096-5588(20)30312-3","article-title":"Anatomic and pathologic studies of the thoracic duct","volume":"34","author":"Kausel","year":"1957","journal-title":"J Thorac Surg"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1002\/ca.22337","article-title":"Review of thoracic duct anatomical variations and clinical implications","volume":"27","author":"Phang","year":"2014","journal-title":"Clin Anat"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1093\/icvts\/ivab100","article-title":"Evaluation of treatment options for postoperative and spontaneous chylothorax in adults","volume":"33","author":"Wiesner","year":"2021","journal-title":"Interact Cardiovasc Thorac Surg."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1093\/oxfordjournals.annonc.a059251","article-title":"Chylothorax in lymphoma: mechanisms and management","volume":"6","author":"O\u2019Callaghan","year":"1995","journal-title":"Ann Oncol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/PL00002305","article-title":"Strahlentherapie von Lymphfisteln und Lymphozelen [Radiotherapy of lymphatic fistula and lymphocele]","volume":"176","author":"Neu","year":"2000","journal-title":"Strahlenther Onkol."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1097\/00007611-197804000-00029","article-title":"Chylothorax and lymphangiomas of bone: unusual manifestations of lymphatic disease","volume":"71","author":"Bell","year":"1978","journal-title":"South Med J."},{"key":"ref16","first-page":"1165","article-title":"Lymphangiomatosis of the mediastinum with chylothorax and chylopericardium: role of radiation treatment","volume-title":"J Thorac Cardiovasc Surg.","author":"Dajee","year":"1994"}],"container-title":["Frontiers in 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