Chylous ascites after whole-abdomen irradiation for gynecologic malignancy

From November 1981 through December 1987, 207 patients received whole-abdomen irradiation (WAI) for gynecologic malignancies at the Mayo Clinic. In seven (3%) of these patients, chylous ascites subsequently developed; one additional patient with chylous ascites after WAI for a gynecologic malignancy was referred to us from another institution. In these eight patients, irradiation was done either adjuvantly (five patients) or as salvage therapy after chemotherapy failure (three patients). Chylous ascites was confirmed by laboratory analysis in six cases and was presumed based on the clinical course in two cases. Mean cumulative radiation doses were 2,925 and 5,122 cGy to the abdomen and pelvis, respectively, with para-aortic boosts administered in six cases to a mean cumulative dose of approximately 4,200 cGy. The mean time from completion of WAI to development of ascites was 12 months (range, 6 to 18 months). In six patients, therapy was conservative-observation and diuretics. Two other patients required multiple paracenteses for relief of abdominal distention. Parenteral nutrition was given to two patients who had associated radiation enteritis. The ascites resolved in all eight cases at a mean of 18 months (range, 8 to 30 months) after development. At a mean follow-up of 57 months after initial diagnosis and 16 months after resolution of the ascites, seven patients are without evidence of disease and one patient died of recurrent carcinoma. Distinguishing this clinical entity from recurrent carcinoma is important because of its benign course and its resolution with conservative management.