Purpose: With the increasing use of CT-imaging-based radiation therapy (RT) planning, postoperative changes following prior pelvic lymph node dissection are now readily identified. The significance of postoperative seromas for complication rates and the development of pelvic abscess during radiation/chemotherapy-related immunosuppression is poorly understood. The purpose of this study was to evaluate the frequency and type of morbidity of RT in gynecologic cancer patients with postoperative seromas identified on RT planning CT.
Methods and Materials: RT planning CT examinations were reviewed to identify postoperative seroma in 36 patients (cervical cancer: 21; endometrial cancer: 15)who had pelvic/para-aortic lymph node dissections prior to RT. The location of each seroma was recorded and the ellipsoid volume of the seroma based on three orthogonal diameters was measured. Dose of RT, interval between surgery and RT start, the use of chemotherapy, and neutrophil count nadir were correlated with the development of pelvic abscess and short and long-term morbidity. The mean interval from surgery to RT start was 24 days (range: 8-56 days). Median follow-up was 6.3 months (range: 1.7-17.8 months).
Results: CT evidence of postoperative pelvic seroma was found in 25 of 36 patients (69%). Sixteen patients had one, 6 had two, 2 had three and 1 had four seromas. Five of the 25 patients with seromas (20%) developed symptomatic pelvic fluid collections/abscesses in the region of the seroma during RT (2 patients) or within 10-187 days (mean: 69 days) after RT completion (3 patients). All resolved with conservative management and none resulted in long-term complications. Number, location, and volume (mean: 42 cm3, range: 1.6-143.7 cm 3) of the seromas did not correlate with abscess formation, but 50% (2/4) of patients with large seromas of ³80 cm3 developed abscesses. All patients with abscess had either concurrent chemotherapy or extended-field radiation. Of those with neutrophil nadirs of £2500 cells/mm3, 31% developed abscess, compared to none with nadirs >2500 cells/mm3 (p=0.06).
Conclusion: Postoperative seroma is a common radiographic finding in patients with preceding lymph node dissection and does not require intervention. However, patients with seroma should be monitored closely for clinical signs of pelvic abscess correlating with the location of the seroma, particularly those receiving chemotherapy, extended-field radiation, and those with low neutrophil counts.
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