Perioperative and postoperative complications of intracavitary radiation for FIGO Stage I-III carcinoma of the cervix

Purpose: To evaluate perioperative and postoperative complications of low-d ose-rate (LDR) intracavitary radiation therapy in patients with FIGO Stage I-III carcinoma of the uterine cervix, Methods and Materials: We retrospectively reviewed the medical and radiothe rapy records of all patients treated with radiation between 1960 and 1992 a t The University of Texas M.D, Anderson Cancer Center for FIGO I-III carcin omas of the cervix, Patients who had had initial hysterectomy or whose trea tment did not include intracavitary irradiation were excluded. The final st udy included 4043 patients who had undergone 7662 intracavitary procedures. Results: Eleven (0.3%) patients had documented or suspected cases of thromb oembolism resulting in 4 deaths, Of these 11 patients, 8 had clinical or ra diographic evidence of tumor involving pelvic nodes or fixed pelvic wall. T he risk of postoperative thromboembolism did not decrease significantly wit h the routine use of mini-dose heparin prophylaxis (p = 0.3), Other life-th reatening perioperative complications included myocardial infarction (1 dea th in 5 patients), cerebrovascular accident (2 patients), congestive heart failure or atrial fibrillation (3 patients), and halothane liver toxicity ( 2 deaths in 2 patients). Intraoperative complications included uterine perf oration (2.8%) and vaginal laceration (0.3%), which occurred more frequentl y in patients greater than or equal to 60 years old (p < 0.01), Fourteen pe rcent of patients had a temperature greater than or equal to 101 degrees F during at least one hospital stay. The only correlation between minor intra operative complications and disease-specific survival was found in patients who had Stage III disease and uterine perforation; survival was significan tly (p = 0.01) decreased in these patients, Conclusions: Fatal or life-threatening complications of intracavitary treat ment were very rare. Deep venous thrombosis (DVT) and pulmonary embolism (P E) did not occur in otherwise healthy patients,vith early disease and were rare even when disease was more advanced. Minor perioperative complications were not correlated with serious late complications or with death from dis ease. (C) 2000 Elsevier Science Inc.