S89
Brachytherapy - Gynaecology
ESTRO 2026
Purpose/Objective: Peri-operative complications in gynaecological brachytherapy are sparsely reported in the literature. High-dose-rate brachytherapy (HDRBT) is an essential component of definitive radiotherapy for cervical and other gynaecological cancers. It requires prolonged bedrest with in-situ applicators, potentially predisposing patients to infection, bleeding, or venous thromboembolism. We analysed peri-operative complications in patients undergoing brachytherapy at our centre, exploring any association with treatment parameters or patient factors. Material/Methods: A retrospective analysis was performed of all patients who underwent HDRBT for gynaecological cancers at our centre between January 2024 and June 2025. Patients received either 3, 4 or 6 fractions delivered in a single interstitial/intercavitary implantation requiring 1, 2, or 3 nights of bedrest respectively. Data were collected on infection, haemorrhage, and thrombosis rates. Infection was defined as the need for antibiotics after pyrexia and clinical signs of infection whilst implant in-situ or on the day of implant removal. Infection could be related to implantation or not. Haemorrhage was defined as bleeding at implant removal requiring vaginal packing and/or blood transfusion. Thrombosis was defined as the development of deep vein thrombosis (DVT) or pulmonary embolism (PE) with the implant in situ and after removal. Associations between complications and patient age, primary disease site, preceding concurrent chemoradiotherapy, number of applicators and fractions were analysed. Results: A total of 115 patients were included. Demographics, receipt of chemotherapy and fraction number are summarised in Table 1. Mean number of interstitial applicators was 11 (4-22). Overall, 40 (35%) patients experienced at least one complication. Thirty-four (30%) patients were treated for infection of which 18 (16%) were directly attributed to implant. Eighteen (16%) patients had pyrexia not prescribed antibiotics. Haemorrhage requiring transfusion or vaginal packing was observed in 5 (4.3%) patients. One patient required emergency surgery for internal bleeding after which she recovered. PE occurred in only 2 (1.7%) patients, neither haemodynamically unstable or requiring thrombolysis. There was no association between the number of fractions or applicators and the development of infection or thromboembolism, however patients with haemorrhage had significantly higher number of applicators
(p<0.05).
Conclusion: In this single-centre analysis, peri-operative
complications following HDRBT were manageable with no serious events apart from one patient with internal bleeding. Infection resulting in antibiotic prescription represented the most frequent event, while haemorrhage and thrombotic complications were rare. The absence of significant associations with treatment or patient factors suggests that current protocols provide safe procedural outcomes across treatment schedules. Keywords: complications, infection, haemorrhage Digital Poster 5004 Image-guided adaptive brachytherapy in locally advanced cervical cancer: lessons from a developing country on dosimetric predictors and outcome Elena Manea 1,2 , Bogdan Cristei 1 , Crina Elena Atitei 1 , Bogdan Cristei 1 , Alexandru Dumitru Zara 3
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