AOS3 Control of urinary, rectal, and sexual symptoms after 3-D conformal radiotherapy for bladder cancer

Abstract

Background Radical cystectomy remains the standard of care for muscle-invasive transitional cell carcinoma of the bladder. A combination of maximum transurethral resection of the bladder tumour, radiation, and concurrent chemotherapy is the hallmark of modern bladder function preserving strategies. Our aim is to describe bladder, rectal, and sexual dysfunctions in survivors after radical radiotherapy for urinary bladder cancer. Methods Twenty patients were treated with 3-D conformal radiotherapy (60–66 Gy in 2 Gy fractions, five fractions per week) on a linear accelerator machine. Median follow-up time was 30 months. For comparison, 20 controls were selected from our annual cancer register. Information was collected anonymously to avoid investigator-related bias using a questionnaire about changes in daily life after radiotherapy. Findings Of the irradiated patients, 80% reported little or no distress from urinary symptoms. Twenty per cent of patients reported that radiotherapy had a moderate to severe impact on their present bladder function, causing dysuria, incontinence, or stenosis that required the use of a bladder catheter. Thirty per cent of irradiated patients reported moderate to severe impact on their present sexual function. Impotence and lack of sexual desire were significantly higher among the male patients who received radiotherapy. Forty per cent of the male patients had regular sexual intercourse (half of whom used aids like sildenafil to sustain erection) and 70% of the male patients reported they had ejaculation. Moderate distress from symptoms of the gastrointestinal tract was reported by 30% of irradiated patients. Diarrhoea was most common, followed by faecal urgency and faecal incontinence. Interpretation After radical radiotherapy, most patients had a well functioning bladder. Radiotherapy is associated with considerable long-term intestinal side-effects because the treatment field includes the bowel. Moreover, radiotherapy can result in sexual dysfunction. Although we do not suggest that selective bladder-sparing treatment should replace radical cystectomy, sufficient data now exists to indicate that it is a valid alternative. The authors declared no conflicts of interest.