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

  • Georg BöningEmail author
  • Laura Büttner
  • Martin Jonczyk
  • Willie Magnus Lüdemann
  • Timm Denecke
  • Dirk Schnapauff
  • Gero Wieners
  • Peter Wust
  • Bernhard Gebauer
Clinical Investigation Non-Vascular Interventions
Part of the following topical collections:
  1. Non-Vascular Interventions

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 Therapeutics Risk factors Hemorrhage Infection 

Abbreviations

BDA

Biliodigestive anastomosis

CCC

Cholangiocarcinoma

CRC

Colorectal cancer

CT-HDRBT

Computed tomography-guided high-dose-rate brachytherapy

CTV

Clinical target volume

DNA

Deoxyribonucleic acid

HCC

Hepatocellular carcinoma

IQR

Interquartile range

IRE

Irreversible electroporation

LITT

Laser-induced thermotherapy

MWA

Microwave ablation

NSCLC

Non-small cell lung cancer

TAE/TACE

Transarterial (chemo-) embolization

PRC

Procedure-related complications

PT

Prothrombin time

PTT

Thromboplastin time

RFA

Radiofrequency ablation

RNA

Ribonucleic acid

SD

Standard deviation

SIR

Society of Interventional Radiology

US

Ultrasound

OR

Odds ratio

Notes

Authors’ Contribution

GB wrote the manuscript und supervised analysis. LB collected the data and performed analysis. MJ and WML supported data collection and analysis. TD, DS, GW, PW and BG performed the interventions. BG supervised study planning and supported manuscript writing. All authors read and approved the final manuscript.

Funding

The authors declare that they received no funding.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics Approval and Consent to Participate

This study been performed in accordance with the Declaration of Helsinki and was approved by the ethics committee of the Charité (EA4/089/17).

Consent for Publication

Written informed consent for the publication was obtained from participants.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Department of Radiology, Charité – Universitätsmedizin BerlinHumboldt University and Free University of Berlin Medical SchoolBerlinGermany
  2. 2.Department of Radiation Oncology and Radiotherapy, Charité – Universitätsmedizin BerlinHumboldt University and Free University of Berlin Medical SchoolBerlinGermany

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