BRACHYTHERAPY-RELATED COMPLICATIONS FOR MEDICALLY INOPERABLE STAGE-I ENDOMETRIAL CARCINOMA

Purpose: The current study was conducted to investigate the incidence and risk factors for medical complications associated with low dose ra te brachytherapy in patients with medically inoperable Stage I endomet rial cancer treated with irradiation alone. Methods and Materials: Fro m 1965 through 1991 at Mallinckrodt Institute of Radiology, 150 implan ts were performed on 96 patients who were deemed medically unfit for h ysterectomy because of advanced age, obesity, and various medical prob lems. The records of these patients were examined retrospectively to d etermine the incidence of medical complications that occurred in the f irst 30 days following the initiation of brachytherapy. The associatio n of risk factors that precluded major surgery and the occurrence of b rachytherapy-related complications was examined by logistic regression . Results: Of these 96 patients, 40 patients were older than 75 years, and 31 patients were deemed morbidly obese. Medical problems included hypertension in 45 patients, and diabetes in 37; there was a history of congestive heart failure in 23, stroke in 11, myocardial infarction in 10, and thromboembolism in 8. There were concurrent malignancies i n five patients. Implants were performed using intrauterine Simon-Heym an capsules, tandems, and vaginal ovoids in all patients. General anes thesia was used for 98 implants, spinal anesthesia for 26, local anest hesia for 25, and epidural anesthesia for 1. The duration of anesthesi a ranged from 30 to 120 min (median, 60 min). The duration of radioiso tope application ranged from 11 to 96 h (median, 46 h). Preventive mea sures included low dose subcutaneous heparin in 55 patients (since 197 8), and intermittent pneumatic compression boots in 29 (since 1985). F our patients developed life-threatening complications including myocar dial infarction (two patients), congestive heart failure (one patient) , and pulmonary embolism (one patient). Two of these four patients die d; one with a myocardial infarction and the other with pulmonary embol ism. The morbidity rate was thus 4.2% (4 out of 96), and the mortality was 2.1% (2 out of 96). Although the four serious complications occur red within 30 days of the procedure, only one complication and one dea th occurred during treatment. There was no correlation between occurre nce of complications and medical risk factors, type and duration of an esthesia, or type and duration of implant. Conclusions: There is a low incidence of complications associated with conventional low dose rate brachytherapy. The procedure is well tolerated in patients with medic ally inoperable Stage I endometrial cancer. In comparison to the predi cted serious complication rate of surgery in these patients, the numbe r of life-threatening complications from brachytherapy appears to be q uite acceptable.