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A prospective analysis of catheter complications for gynecological cancers treated with interstitial brachytherapy in the 3D era
Lucas C. Mendez1, Pencilla Lang1, Chirag Patel2, David D’Souza3, Adam Gladwish4, Laura D’Alimonte1, Amandeep Taggar1, Elizabeth Barnes1, Lisa Barbera1, Eric Leung1,* 1Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada 2Department of Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada 3Department of Radiation Oncology, London Regional Cancer Program, Western University, London, Ontario, Canada 4Royal Victoria Hospital, Barrie, Ontario, Canada
ABSTRACT PURPOSE: Perineal interstitial brachytherapy (P-ISBT) is an important component in the treat-
ment of locally advanced gynecological cancers. However, there are concerns about potential acute
complications from catheter needles. The goal is to evaluate the safety of P-ISBT by studying acute
complications and radiological organ needle intrusions.
MATERIALS AND METHODS: Forty-eight patients with gynecological cancers treated with P-
ISBT at a single institution from September 2014 to April 2016 were included in a prospective reg-
istry trial. Postoperative adverse events were recorded during inpatient stay and at 6-week followup.
Postprocedure CT and MRI images were reviewed by two physicians to record the number of nee-
dles intruded into organs. Discrepancies were resolved by a radiologist.
RESULTS: Median followup time was at least 3 months. Forty-two patients were initially treated
with external beam radiation therapy, median dose of 45 Gy. A total of 73 insertions were per-
formed. The median number of needles for first and second insertions was 17 and 19, respectively.
Twenty-eight patients had radiological evidence of needle intrusion(s) into at least one pelvic organ.
The most commonly intruded organs were large bowel (18 cases) and bladder (18), followed by
rectum (12). A total of nine acute toxicities from needle intrusions were found: four hematuria
testinal complications were found.
CONCLUSIONS: Perineal ISBT is an effective treatment for gynecological cancers. Despite oc-
casional radiological catheter intrusions, there are low rates of organ complications. Concern of
needle complications from P-ISBT should not be a barrier to adopting this technique for effective
treatment. 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved. Keywords: Gynecological malignancies; Perineal interstitial brachytherapy; Acute complications
Locally advanced gynecological cancers are challenging diseases that can cause significant morbidity for patients through their sensitive location in the pelvis. The tumor is often closely associated to adjacent organs, which limits
Conflict of interest: All authors have no conflict of interest regarding this publication.