Complications of Computed Tomography-Guided High-Dose-Rate Brachytherapy (CT-HDRBT) and Risk Factors: Results from More than 10 Years of Experience

Abstract

Purpose: For local ablation of unresectable tumors, computed tomography-guided high-dose-rate brachytherapy (CT-HDRBT) is a minimally invasive therapeutic option involving CT-guided catheter placement and high-dose-rate irradiation with iridium-192. Possible complications are related to transcutaneous puncture, retraction of the applicator, and delivery of brachytherapy. To classify CT-HDRBT in comparison with other minimally invasive therapeutic options, it is essential to know the probability of complications and their risk factors. This study therefore aimed at quantifying the occurrence of complications in CT-HDRBT and identifying potential risk factors.

Materials and methods: Over a period of more than 10 years from 2006 to 2017, 1877 consecutive CT-HDRBTs were performed at our center and retrospectively analyzed. In 165 cases, CT-HDRBT was combined with transarterial (chemo-) embolization. Information on complications and potential risk factors was retrospectively retrieved from electronic documentation. Statistical analysis of the data was performed.

Results: No complications occurred in 85.6% of the interventions. The most common complications were bleeding (5.6%), infection (2.0%), and prolonged pain (1.5%). Summarized diameter (defined as sum of maximum diameters in axial orientation) of treated tumor lesions (odds ratio 1.008; p < 0.001), target lesion site (odds ratio 1.132; p = 0.033), combined treatment (odds ratio 1.233; p = 0.038), and the presence of biliodigestive anastomosis (BDA) (odds ratio 1.824; p = 0.025) were identified as risk factors.

Conclusions: CT-HDRBT is a safe minimally invasive therapeutic option. Summarized diameter of treated tumor lesions, target lesion site, combined treatment, and presence of BDA are risk factors for complications.

Keywords: Brachytherapy; Hemorrhage; Infection; Risk factors; Therapeutics.