Complications of Computed Tomography-Guided High-Dose-Rate Brachytherapy (CT-HDRBT) and Risk Factors: Results from More than 10 Years of Experience

  • Georg BöningEmail author
  • Laura Büttner
  • Martin Jonczyk
  • Willie Magnus Lüdemann
  • Timm Denecke
  • Dirk Schnapauff
  • Gero Wieners
  • Peter Wust
  • Bernhard Gebauer
Clinical Investigation Non-Vascular Interventions
Part of the following topical collections:
  1. Non-Vascular Interventions



For local ablation of unresectable tumors, computed tomography-guided high-dose-rate brachytherapy (CT-HDRBT) is a minimally invasive therapeutic option involving CT-guided catheter placement and high-dose-rate irradiation with iridium-192. Possible complications are related to transcutaneous puncture, retraction of the applicator, and delivery of brachytherapy. To classify CT-HDRBT in comparison with other minimally invasive therapeutic options, it is essential to know the probability of complications and their risk factors. This study therefore aimed at quantifying the occurrence of complications in CT-HDRBT and identifying potential risk factors.

Materials and Methods

Over a period of more than 10 years from 2006 to 2017, 1877 consecutive CT-HDRBTs were performed at our center and retrospectively analyzed. In 165 cases, CT-HDRBT was combined with transarterial (chemo-) embolization. Information on complications and potential risk factors was retrospectively retrieved from electronic documentation. Statistical analysis of the data was performed.


No complications occurred in 85.6% of the interventions. The most common complications were bleeding (5.6%), infection (2.0%), and prolonged pain (1.5%). Summarized diameter (defined as sum of maximum diameters in axial orientation) of treated tumor lesions (odds ratio 1.008; p < 0.001), target lesion site (odds ratio 1.132; p = 0.033), combined treatment (odds ratio 1.233; p = 0.038), and the presence of biliodigestive anastomosis (BDA) (odds ratio 1.824; p = 0.025) were identified as risk factors.


CT-HDRBT is a safe minimally invasive therapeutic option. Summarized diameter of treated tumor lesions, target lesion site, combined treatment, and presence of BDA are risk factors for complications.


Brachytherapy Therapeutics Risk factors Hemorrhage Infection 



Biliodigestive anastomosis




Colorectal cancer


Computed tomography-guided high-dose-rate brachytherapy


Clinical target volume


Deoxyribonucleic acid


Hepatocellular carcinoma


Interquartile range


Irreversible electroporation


Laser-induced thermotherapy


Microwave ablation


Non-small cell lung cancer


Transarterial (chemo-) embolization


Procedure-related complications


Prothrombin time


Thromboplastin time


Radiofrequency ablation


Ribonucleic acid


Standard deviation


Society of Interventional Radiology




Odds ratio


Authors’ Contribution

GB wrote the manuscript und supervised analysis. LB collected the data and performed analysis. MJ and WML supported data collection and analysis. TD, DS, GW, PW and BG performed the interventions. BG supervised study planning and supported manuscript writing. All authors read and approved the final manuscript.


The authors declare that they received no funding.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics Approval and Consent to Participate

This study been performed in accordance with the Declaration of Helsinki and was approved by the ethics committee of the Charité (EA4/089/17).

Consent for Publication

Written informed consent for the publication was obtained from participants.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Department of Radiology, Charité – Universitätsmedizin BerlinHumboldt University and Free University of Berlin Medical SchoolBerlinGermany
  2. 2.Department of Radiation Oncology and Radiotherapy, Charité – Universitätsmedizin BerlinHumboldt University and Free University of Berlin Medical SchoolBerlinGermany

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