Clinical risk factors for early complications after high-dose-rate endobronchial brachytherapy in the palliative treatment of lung cancer.

PURPOSE

This study sought to identify the rate of complications and clinical risk factors for early complications of high-dose-rate endobronchial brachytherapy (HDR-EBBT). The identification of these risk factors could result in a decrease or avoidance of complications.

PATIENTS AND METHODS

We analyzed risk factors for complications in 761 patients with advanced-stage lung cancer who were treated with HDR-EBBT as a part of the multimodality therapy. We reviewed patient, radiology, and bronchology charts for complications of HDR-EBBT. Complications were defined as severe hypoxemia, global respiratory failure, cardiac arrhythmia requiring additional treatment, hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, and death. Risk factors were defined as acute myocardial infarction > or = 6 months previously, stabilized hypertension, arrhythmia, chronic obstructive pulmonary disease (COPD), stabilized cardiomyopathy, previous external-beam radiation therapy, chemotherapy, and interventional pulmonology treatment. Age, sex, tumor histology, and tumor localization were also subjected to multivariate analyses.

RESULTS

The rate of complications was 5.4%. Statistically significant (P = .001) risk factors for complications of HDR-EBBT included stabilized hypertension, controlled chronic cardiac arrhythmias, COPD, and stabilized cardiomyopathy. We found a significant correlation between age and number of risk factors, and the occurrence of complications (P = .001).

CONCLUSION

Our results indicate that closer monitoring of patients with identified risk factors is advisable. Such monitoring should be performed both before and after treatment, to avoid complications.