Current management and proposal for guidance of radiation cystitis (RC): Results of a British Uro-oncology Group (BUG) survey.

Abstract

297 Background: Although RC is a potentially significant acute and/or chronic complication of radiotherapy to the pelvic area (15-20% incidence), there is limited information about how it is managed in practice. Methods: The BUG membership (comprising of consultant Uro-oncologists) was surveyed as to their perception on and management of RC. Results: 87% (45/52) of respondents supervise radiotherapy to the bladder/pelvis. Of these 45, most consider acute RC during or immediately after treatment a significant problem in ‘some' (56%) or the ‘majority' (11%) of cases (‘minority': 33%). Late RC was mostly considered a significant problem in the ‘minority' of cases (73%), with the rest feeling it was a significant problem in ‘some' cases (27%). During radiotherapy or at follow-up the majority ‘always' (22%) or ‘sometimes' (60%) record the grade of cystitis (‘never': 18%). 93% do not have local guidelines for managing RC. The treatments most frequently used to treat acute RC are: fluids (71%); cranberry juice (36%); analgesia (36%); non-steroidal anti-inflammatory drugs (NSAIDs; 29%); and anti-spasmodics (18%). Mild late RC is treated similarly (fluids: 29%; analgesia: 22%; cranberry juice: 18%; NSAIDs: 16%), although 20% might consider no treatment. For moderate/severe late RC, most refer to an urologist (64%), with grade ≥2 cases, those with haemorrhagic cystitis (20%), and symptoms >90 days post-radiotherapy (18%) being the most common reasons for referral. For those treating moderate/severe late RC, hyperbaric oxygen (38%), fluids (19%), and analgesia (19%) are most commonly used. Over half were not aware of alternative treatment options including mesna (69% not aware), sodium hyaluronate (62%), intravesical prostaglandin E1/E2 (62%), sodium pentosanpolysulphate (60%), or intravesical formalin (51%). All supported the development of national guidelines in collaboration with the British Association of Urological Surgeons and British Association of Urology Nurses. Conclusions: RC is acknowledged as a potentially significant issue, and, with the majority of cases managed by oncology, there is a recognised need for further guidance on optimal treatment and BUG has started this work.