Management Of Radiation Cystitis Research Articles

Incidence and Management of Radiation Cystitis After Pelvic Radiotherapy for Prostate Cancer: Analysis From a National Database

ObjectivesTo determine the incidence of radiation cystitis on Prostate Cancer (PCa) patients undergoing pelvic radiotherapy (RT), evaluating the most used management strategies, and identifying potential risk factors associated with the development of this condition. MethodsA retrospective analysis was conducted using the PearlDiver™ Mariner database, containing patient records compiled between 2011 and 2022. International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were employed to identify population and outcomes. We evaluated patients who underwent RT for PCa and subsequently developed radiation cystitis. Primary objective was to determine the overall incidence of radiation cystitis. Furthermore, we investigated its associated risk factors and management. ResultsA total of 274,865 PCa patients underwent RT during the study period. Of these, 48,713 (17.7%) experienced hematuria following RT, while 7,721 (2.8%) were diagnosed with radiation cystitis. After the diagnosis, 2,307 patients (29.9%) received diagnostic or therapeutic endoscopic interventions. Only 59 patients (0.76%) underwent endovascular embolization, while 151 patients (1.95%) required cystectomy. Hyperbaric oxygen therapy, administered to 1,287 patients (16.67%), was the only treatment that displayed a significant upward trend. Multivariate logistic regression identified obesity (OR 1.29; 95% C.I. 1.23 — 1.35), smoking (OR 1.27; 95% C.I. 1.22 — 1.33), and diabetes (OR 1.32; 95% C.I. 1.26 — 1.39), as significant risk factors for radiation cystitis (all p-values < 0.001). ConclusionsRadiation cystitis represents a rare complication after pelvic RT with significant clinical impact. Its incidence has remained stable throughout the study period. The identified risk factors corroborate the pathophysiology of radiation cystitis. Hyperbaric oxygen therapy was the only treatment to show an upward trend during the study period.

Does renal failure worsen radiation cystitis following radical prostatectomy?

To investigate the impact of renal function on the risk, severity, and management of radiation cystitis in patients who underwent postoperative radiation therapy for prostate cancer. Retrospective data was assessed from patients treated with adjuvant/salvage radiation therapy at a single academic institution between 2006 and 2020. The incidence, severity, and management of radiation cystitis were compared between three groups: CKD 0-2, CKD 3-4, and CKD 5. Associations of clinicopathologic factors with radiation cystitis were assessed in univariate and multivariate Cox regression models. A total of 110 patients who underwent radiation therapy following robot-assisted laparoscopic radical prostatectomy were included. The incidence of radiation cystitis following postoperative radiation therapy was 17% with a median presentation time of 34months (interquartile range 16-65months). The incidence of radiation cystitis was 100% in CKD 5 patients compared to 15% in CKD 0-2 and 17% in CKD 3-4 patients (p < 0.001). CKD 5 patients required more treatments, emergency department visits, and longer hospitalization times than CKD 0-4 patients (all p < 0.001). Multivariate analyses identified CKD 5 as the only significant factor associated with radiation cystitis (HR = 10.39, p = 0.026). End-stage renal failure is associated with the risk and severity of radiation cystitis in patients receiving postoperative radiation therapy. Knowledge of the potential morbidity of this complication in this population could guide physicians and patients as they evaluate risks and benefits prior to selecting adjuvant or salvage radiation therapy.

Radiation cystitis: A late effect of radiotherapy in a patient with cervical rhabdomyosarcoma

We report the case of a 22-year old female presenting with an embryonal rhabdomyosarcoma of the cervix that was successfully treated by surgery followed by adjuvant radiation therapy and chemotherapy. She subsequently developed radiation cystitis after 10 years of follow-up. She was successfully treated with cystoscopic fulguration. In this report, we discuss a review of management strategies for cervical rhabdomyosarcoma and also throw some light on incidence and management of radiation cystitis after pelvic radiotherapy. We discuss the dose independence of radiation cystitis, which can be seen after as low as 4500 cGy of pelvic radiation.

Лечение постлучевых повреждений мочевого пузыря

To investigate the role of hyperbaric oxygen therapy in the management of patients with radiation induced urinary bladder injury (radiation cystitis). The study comprised 23 patients with late radiation induced urinary bladder injury who were evaluated and treated using hyperbaric oxygen therapy and bladder instillation. Before and after treatment, all patients underwent cystoscopy with the bladder mucosa biopsy. In all patients, the treatment resulted in positive outcomes manifested by resolution of hematuria, alleviation of dysuria, decrease in urination frequency to 6.5 +/- 0.5 times a day, increase the bladder capacity, which ultimately improved patients the quality of life. Hyperbaric oxygen therapy was well tolerated, there were no adverse effects. Morphological studies confirmed positive clinical changes following hyperbaric oxygen therapy. The study findings support wider use of hyperbaric oxygen therapy in the management of radiation cystitis.

Cranberry in radiotherapy: dispelling the myths. A review of the literature

AbstractBackgroundTherapeutic radiographers routinely offer advice to patients regarding treatment-related side effects. Cranberry has long been used as a natural remedy for several health complaints and has more recently been suggested as having a role in the treatment and prophylaxis of urinary tract infection (UTI) and symptoms.PurposeThe aim of this review was to investigate whether there is a place for cranberry as part of the management of radiation cystitis caused by radiotherapy treatment of pelvic cancers, in order to aid therapeutic radiographers in tailoring their advice regarding pelvic side effects.Materials and methodsA structured search was carried out using PubMed, CINAHL, Scopus and Cochrane Library databases. A total of 25 articles were selected for review.ResultsThemes of mechanism of action of cranberry, composition of cranberry products, cranberry and UTI, use of cranberry in radiotherapy and further issues to consider were identified and explored.ConclusionA lack of high-quality data was identified in the literature reviewed and no firm evidence was found to support the continued recommendation of cranberry as part of management of radiation induced urinary tract side effects. Well-designed randomised controlled trials are required before further recommendations regarding the use of cranberry in radiotherapy are made.

Use of hyperbaric oxygen therapy in management of radiation cystitis

Radiation induced tissue injury is a result of progressive endarteritis which leads to hypovascular, hypocellular and hypoxic tissues. This damage begins as soon as patient is exposed to radiation beam. Most patients experience some acute side effects and it is rare and serious event when late side effects develop. Radiation cystitis is a late complication of radiotherapy for pelvic malignancies like prostate and cervix. Although 85% of the cases resolve with conservative management, the remainder become refractory and progress to involve a more extensive area of bony and soft tissue. Hyperbaric oxygen therapy (HBOT) is used to treat various forms of chronic radiation tissue injury and is a potential primary option for management of radiation cystitis by enhancing healing in such cases by increasing vascular density and oxygen levels in irradiated tissues. We report a case of 60-year-old male with radiation cystitis who showed promising improvement and resolution of his symptoms after forty HBOT sessions.

Management of radiation cystitis

Acute radiation cystitis occurs during or soon after radiation treatment. It is usually self-limiting, and is generally managed conservatively. Late radiation cystitis, on the other hand, can develop from 6 months to 20 years after radiation therapy. The main presenting symptom is hematuria, which may vary from mild to severe, life-threatening hemorrhage. Initial management includes intravenous fluid replacement, blood transfusion if indicated and transurethral catheterization with bladder washout and irrigation. Oral or parenteral agents that can be used to control hematuria include conjugated estrogens, pentosan polysulfate or WF10. Cystoscopy with laser fulguration or electrocoagulation of bleeding points is sometimes effective. Injection of botulinum toxin A in the bladder wall may relieve irritative bladder symptoms. Intravesical instillation of aluminum, placental extract, prostaglandins or formalin can also be effective. More-aggressive treatment options include selective embolization or ligation of the internal iliac arteries. Surgical options include urinary diversion by percutaneous nephrostomy or intestinal conduit, with or without cystectomy. Hyperbaric oxygen therapy (HBOT) involves the administration of 100% oxygen at higher than atmospheric pressure. The reported success rate of HBOT for radiation cystitis varies from 60% to 92%. An important multicenter, double-blind, randomized, sham-controlled trial to evaluate the effectiveness of HBOT for refractory radiation cystitis is currently being conducted.

TREATMENT OF RADIATION INDUCED HEMORRHAGIC CYSTITIS WITH HYPERBARIC OXYGEN: LONG-TERM FOLLOWUP

Purpose Hemorrhagic cystitis is a recognized possible side effect of therapeutic radiation administered for a variety of pelvic malignancies. Patients may experience pain, bleeding and clot retention. Various palliative treatments, including instillation of alum, silver nitrate and formalin, may be unsuccessful in alleviating patient symptoms. Hyperbaric oxygen therapy is often used to treat poorly healing wounds. We assess the long-term efficacy of hyperbaric oxygen therapy in treating the manifestations of radiation induced injury to the bladder. Materials and Methods A total of 11 patients with radiation induced hemorrhagic cystitis, confirmed by cystoscopy and biopsy, were treated with hyperbaric oxygen therapy. Symptoms included intractable hematuria in all 11 patients, and some also had other voiding symptoms, including persistent suprapubic pain and urinary urgency. In all patients most other types of management had failed and there was no evidence of active infection or recurrent malignancy. Patients received 100% oxygen in a hyperbaric chamber at 2.0 atmospheres for 90 minutes 5 days a week. Average number of treatments was 40 and median followup was 5.1 years. Results Of these 11 patients 3 (27%) experienced complete and durable resolution of symptoms, 3 had persistent symptoms despite hyperbaric treatments and required supravesical urinary diversion, and 5 initially responded to hyperbaric oxygen therapy but experienced long-term recurrent symptoms necessitating urinary diversion as definitive therapy. Conclusions Hyperbaric oxygen offers a noninvasive therapeutic alternative in the management of radiation cystitis. It appears to produce good short-term benefits but it often does not produce definitive long-term cure of the disease process.

Treatment of radiation induced hemorrhagic cystitis with hyperbaric oxygen: long-term followup.

Hemorrhagic cystitis is a recognized possible side effect of therapeutic radiation administered for a variety of pelvic malignancies. Patients may experience pain, bleeding and clot retention. Various palliative treatments, including instillation of alum, silver nitrate and formalin, may be unsuccessful in alleviating patient symptoms. Hyperbaric oxygen therapy is often used to treat poorly healing wounds. We assess the long-term efficacy of hyperbaric oxygen therapy in treating the manifestations of radiation induced injury to the bladder. A total of 11 patients with radiation induced hemorrhagic cystitis, confirmed by cystoscopy and biopsy, were treated with hyperbaric oxygen therapy. Symptoms included intractable hematuria in all 11 patients, and some also had other voiding symptoms, including persistent suprapubic pain and urinary urgency. In all patients most other types of management had failed and there was no evidence of active infection or recurrent malignancy. Patients received 100% oxygen in a hyperbaric chamber at 2.0 atmospheres for 90 minutes 5 days a week. Average number of treatments was 40 and median followup was 5.1 years. Of these 11 patients 3 (27%) experienced complete and durable resolution of symptoms, 3 had persistent symptoms despite hyperbaric treatments and required supravesical urinary diversion, and 5 initially responded to hyperbaric oxygen therapy but experienced long-term recurrent symptoms necessitating urinary diversion as definitive therapy. Hyperbaric oxygen offers a noninvasive therapeutic alternative in the management of radiation cystitis. It appears to produce good short-term benefits but it often does not produce definitive long-term cure of the disease process.