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An analysis of acute complications and perioperative morbidity from high dose rate brachytherapy in the treatment of gynecological malignancies

Abstract

Purpose: To evaluate the acute morbidity and mortality for high dose-rate (HDR) brachytherapy performed in an outpatient setting in the treatment of gynecological malignancies, and to identify possible risk factors for adverse outcomes. Materials and Methods: One hundred seventy-one patients with cervical (n=129) or uterine (n=42) carcinoma with an intact uterus were evaluated and treated from August 1989 through December 1994, with at least part of their therapy delivered with intracavitary HDR {sup 192}Ir radiation. A total of 830 ICR insertions were performed with greater than 95% done on an outpatient basis under heavy intravenous sedation using fentanyl and midazolam. Perioperative morbidity and mortality were recorded for any event occurring within 30 days of the completion of therapy. Anesthesia risk was evaluated retrospectively in all patients based on the American Society of Anesthesiologists' (ASA) Physical Class System. Results: The uterine patients, many treated with radiation alone because of morbid obesity or medical inoperability, had a significantly higher perioperative morbidity and mortality rate as compared to the cervix patient cohort. Thirteen of the 42 (31%) uterine patients and 8 of the 129 (6%) cervix patients required hospitalization within 30 days of treatment completion (p<0.001). Four of these uterine patients (10%) died  More>>
Publication Date:
Jul 01, 1995
Product Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 32; Journal Issue: 971; Other Information: Copyright (c) 1995 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); PBD: 1995
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ACUTE IRRADIATION; ANESTHESIA; ANTINEOPLASTIC DRUGS; CARCINOMAS; DOSE RATES; GYNECOLOGY; IRIDIUM 192; RADIATION SOURCE IMPLANTS; RADIOTHERAPY; RISK ASSESSMENT; SIDE EFFECTS; UROGENITAL SYSTEM DISEASES
OSTI ID:
20420683
Country of Origin:
United States
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0360-3016; IOBPD3; TRN: US03R1920005088
Submitting Site:
INIS
Size:
page(s) 224
Announcement Date:

Citation Formats

Sarkaria, Jann N, Petereit, Daniel G, Kinsella, Timothy J, and Buchler, Dolores A. An analysis of acute complications and perioperative morbidity from high dose rate brachytherapy in the treatment of gynecological malignancies. United States: N. p., 1995. Web. doi:10.1016/0360-3016(95)97828-O.
Sarkaria, Jann N, Petereit, Daniel G, Kinsella, Timothy J, & Buchler, Dolores A. An analysis of acute complications and perioperative morbidity from high dose rate brachytherapy in the treatment of gynecological malignancies. United States. doi:10.1016/0360-3016(95)97828-O.
Sarkaria, Jann N, Petereit, Daniel G, Kinsella, Timothy J, and Buchler, Dolores A. 1995. "An analysis of acute complications and perioperative morbidity from high dose rate brachytherapy in the treatment of gynecological malignancies." United States. doi:10.1016/0360-3016(95)97828-O. https://www.osti.gov/servlets/purl/10.1016/0360-3016(95)97828-O.
@misc{etde_20420683,
title = {An analysis of acute complications and perioperative morbidity from high dose rate brachytherapy in the treatment of gynecological malignancies}
author = {Sarkaria, Jann N, Petereit, Daniel G, Kinsella, Timothy J, and Buchler, Dolores A}
abstractNote = {Purpose: To evaluate the acute morbidity and mortality for high dose-rate (HDR) brachytherapy performed in an outpatient setting in the treatment of gynecological malignancies, and to identify possible risk factors for adverse outcomes. Materials and Methods: One hundred seventy-one patients with cervical (n=129) or uterine (n=42) carcinoma with an intact uterus were evaluated and treated from August 1989 through December 1994, with at least part of their therapy delivered with intracavitary HDR {sup 192}Ir radiation. A total of 830 ICR insertions were performed with greater than 95% done on an outpatient basis under heavy intravenous sedation using fentanyl and midazolam. Perioperative morbidity and mortality were recorded for any event occurring within 30 days of the completion of therapy. Anesthesia risk was evaluated retrospectively in all patients based on the American Society of Anesthesiologists' (ASA) Physical Class System. Results: The uterine patients, many treated with radiation alone because of morbid obesity or medical inoperability, had a significantly higher perioperative morbidity and mortality rate as compared to the cervix patient cohort. Thirteen of the 42 (31%) uterine patients and 8 of the 129 (6%) cervix patients required hospitalization within 30 days of treatment completion (p<0.001). Four of these uterine patients (10%) died of medical complications related to therapy or disease progression within 30 days, while 2 of the cervix patients (1.5%) died: one from disease progression and the other due to radiation enteritis (p=0.05). Preliminary analysis suggests that uterine patients with a high anesthesia risk score (ASA>2) experienced greater morbidity and mortality, while the best predictor of complications in the cervix patients was age greater than 70 years. For the entire cohort of patients, no correlation was found between the 30 day morbidity and mortality and the doses of fentanyl and midazolam used or the length of the procedure. Conclusions: The acute complication rate from HDR brachytherapy performed on an outpatient basis with heavy intravenous sedation is acceptable for the great majority of patients who present for treatment. However, the high morbidity and mortality experienced by certain patient cohorts suggests that careful assessment of the risk/benefit ratio for treatment should be performed in certain high risk patients.}
doi = {10.1016/0360-3016(95)97828-O}
journal = {International Journal of Radiation Oncology, Biology and Physics}
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}