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Ribeiro LDS, Silveira RCDCP, Vasques CI, de Menêses AG, Dos Reis PED, Ferreira EB. Hyaluronic acid to manage radiotoxicities in gynecological cancer patients: a scoping review. Support Care Cancer 2024; 32:439. [PMID: 38888632 DOI: 10.1007/s00520-024-08614-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/28/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE This study aimed to map the use of hyaluronic acid (HA) in preventing and controlling radiotoxicity in women with gynecological cancer undergoing radiotherapy. METHODS We conducted a scoping review of eight electronic databases: CINAHL, Cochrane CENTRAL, LILACS, PubMed, Scopus, Embase, LIVIVO, and the Web of Science Core Collection. In addition, a grey literature search was performed using Google Scholar and ProQuest Dissertations & Theses Global. A manual search was also identified additional references. The search was conducted on May 18, 2023. We included primary studies, reviews, and guidelines that discussed the use of HA to prevent and manage the toxicities resulting from gynecological radiotherapy. RESULTS Eighteen studies were included in this scoping review, published between 2009 and 2022. There was heterogeneity in the use of HA, particularly in the method of application (moisturizing gel, vaginal ovules, spacer gel, and bladder instillations). Furthermore, the radiotoxicities varied among studies, encompassing, among others, vaginal atrophy, dryness, dyspareunia, telangiectasis, adhesions, vaginal stenosis, bleeding, hematuria, and bladder issues. Most studies addressed the potential benefits of HA in managing the signs and symptoms resulting from radiotherapy. CONCLUSION HA has been utilized in clinical practice, in various formulations, for managing signs and symptoms in patients with gynecological cancer undergoing radiotherapy. However, further studies are necessary to thoroughly investigate the most effective method of HA application and its effectiveness in managing radiotoxicity.
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Affiliation(s)
- Letícia da Silva Ribeiro
- University of Brasilia, School of Health Sciences, Nursing Department, Campus Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Renata Cristina de Campos Pereira Silveira
- University of São Paulo, Ribeirão Preto College of Nursing, General and Specialized Nursing Department, WHO Collaborating Centre for Nursing Research Development, Bandeirantes Avenue, 3900, Campus-Monte Alegre, Ribeirão Preto, SP, 14040-902, Brazil
| | - Christiane Inocêncio Vasques
- University of Brasilia, School of Health Sciences, Nursing Department, Campus Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Amanda Gomes de Menêses
- University of Brasilia, School of Health Sciences, Nursing Department, Campus Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Paula Elaine Diniz Dos Reis
- University of Brasilia, School of Health Sciences, Nursing Department, Campus Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Elaine Barros Ferreira
- University of Brasilia, School of Health Sciences, Nursing Department, Campus Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil.
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Bologna E, Licari LC, Franco A, Ditonno F, Manfredi C, De Nunzio C, Antonelli A, De Sio M, Coogan C, Vourganti S, Leonardo C, Simone G, Autorino R. Incidence and Management of Radiation Cystitis After Pelvic Radiotherapy for Prostate Cancer: Analysis from a National Database. Urology 2024:S0090-4295(24)00308-X. [PMID: 38692496 DOI: 10.1016/j.urology.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES To 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. METHODS A 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. RESULTS A 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). CONCLUSIONS Radiation 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.
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Affiliation(s)
- Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA; Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Leslie Claire Licari
- Department of Urology, Rush University, Chicago, IL, USA; Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA; Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA; Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA; Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | - Costantino Leonardo
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
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Liu P, Bai K, Zhang Z, Sun J. Analysis of early clinical signs and risk factors for severe hemorrhagic cystitis after stem cell transplantation in children. Int J Urol 2024; 31:335-341. [PMID: 38180136 DOI: 10.1111/iju.15365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION To analyze the characteristics of early clinical symptoms of hemorrhagic cystitis (HC) after hematopoietic stem cell transplantation (HSCT) and the risk factors of severe HC. METHODS We retrospectively analyzed 77 children with post-HSCT HC treated at our hospital between June 2013 and June 2021. Clinical characteristics were collected and catalogued. RESULTS Among the children with urinary tract irritation symptoms (UTIS) as the first symptom, symptoms appeared earlier than hematuria symptoms (28 day vs. 31 day, p = 0.027), and the time progressing to severe HC was significantly longer in these children (12 day vs. 7 day, p = 0.038), but there was no significant difference in the number of participants (57.8% vs. 59.4%, p = 0.889). BK polyomavirus (BKV) infection was an independent risk factor (hazard ratio [HR] = 2.782, p = 0.035) for severe HC, which was also positively associated with multi-viral infection (HR = 2.215, p = 0.020). CONCLUSIONS In HC children, when the first urinary tract symptom was UTIS, it appeared earlier than hematuria, and the time of progression to severe HC was significantly longer, suggesting that we still need more aggressive treatment for these children to prevent the worsening of symptoms. The severity of HC was positively correlated with BKV infection and multiple infections.
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Affiliation(s)
- Pengtao Liu
- Department of Urology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaiping Bai
- Department of Urology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyuan Zhang
- Department of Urology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Sun
- Department of Urology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Yao J, Chen Y, Zhang X, Chen J, Zhou C, Jiang J, Zhang H, Wu K. Slightly photo-crosslinked chitosan/silk fibroin hydrogel adhesives with hemostasis and anti-inflammation for pro-healing cyclophosphamide-induced hemorrhagic cystitis. Mater Today Bio 2024; 25:100947. [PMID: 38298562 PMCID: PMC10826334 DOI: 10.1016/j.mtbio.2024.100947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 02/02/2024] Open
Abstract
Cyclophosphamide is commonly used in the treatment of various cancers and autoimmune diseases, while concurrently imposing substantial toxicity on the bladder, frequently manifesting hemorrhagic cystitis. Intravesical interventions, such as hyaluronic acid supplementation, present a therapeutic strategy to reinstate bladder barrier function and alleviate the effects of metabolic toxicants. However, it remains a great challenge to achieve efficient cyclophosphamide-induced hemorrhagic cystitis (CHC) management with accelerated tissue repair owing to the low wet-adhesion, poor hemostasis, and acute inflammatory responses. To address these issues, a hemostatic and anti-inflammatory hydrogel adhesive of chitosan methylacryloyl/silk fibroin methylacryloyl (CHMA/SFMA) is developed for promoting the healing of CHC. The obtained hydrogels show a high adhesive strength of 26.21 N/m with porcine bladder, facilitating the rapid hemostasis within 15 s, and reinstate bladder barrier function. Moreover, this hydrogel adhesive promotes the proliferation and aggregation of SV-HUC-1 and regulates macrophage polarization. Implanting the hydrogels into CHC bladders of a SD rat model, they not only can be completely biodegraded in 14 days, but also effectively control hematuria and inflammation, and accelerate angiogenesis, thereby significantly promote the healing of bladder injury. Overall, CHMA/SFMA hydrogels exhibit rapid hemostasis for treating CHC and accelerate muscle tissue repair via angiogenesis and inflammation amelioration, which may provide a new path for managing severe hemorrhagic cystitis in the clinics.
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Affiliation(s)
- Jie Yao
- Department of Urology, Translational Research Laboratory for Urology, Ningbo Clinical Research Center for Urological Disease, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
| | - Yaoqi Chen
- Department of Urology, Translational Research Laboratory for Urology, Ningbo Clinical Research Center for Urological Disease, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
| | - Xiang Zhang
- Department of Urology, Translational Research Laboratory for Urology, Ningbo Clinical Research Center for Urological Disease, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
| | - Junfeng Chen
- Department of Urology, Translational Research Laboratory for Urology, Ningbo Clinical Research Center for Urological Disease, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
| | - Cheng Zhou
- Department of Urology, Translational Research Laboratory for Urology, Ningbo Clinical Research Center for Urological Disease, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
| | - Junhui Jiang
- Department of Urology, Translational Research Laboratory for Urology, Ningbo Clinical Research Center for Urological Disease, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
| | - Hua Zhang
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou, Zhejiang, 310027, China
- Research Institute of Smart Medicine and Biological Engineering, Ningbo University, Ningbo, Zhejiang, 315211, China
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
| | - Kerong Wu
- Department of Urology, Translational Research Laboratory for Urology, Ningbo Clinical Research Center for Urological Disease, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
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Shoji S, Naruse J, Oda K, Kuroda S, Umemoto T, Nakajima N, Hasegawa M, Mukasa A, Koizumi N, Miyajima A. Current status and future outlook of ultrasound treatment for prostate cancer. J Med Ultrason (2001) 2023:10.1007/s10396-023-01368-x. [PMID: 37787881 DOI: 10.1007/s10396-023-01368-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/17/2023] [Indexed: 10/04/2023]
Abstract
Radical prostatectomy and radiation therapy are the standard treatment options for localized prostate cancer (PC). However, radical prostatectomy may cause the deterioration of urinary and sexual function, and radiation-induced hemorrhagic cystitis and severe rectal bleeding are risk factors for fatal conditions in patients after radiation therapy. With the recent development of magnetic resonance imaging (MRI) for the localization of clinically significant PC (csPC) and treatment modalities, "focal therapy", which cures csPC while preserving anatomical structures related to urinary and sexual functions, has become a minimally invasive treatment for localized PC. Based on the clinical results of transrectal high-intensity focused ultrasound (HIFU) for localized PC in the whole gland and focal therapy, HIFU is considered an attractive treatment option for focal therapy. Recently, the short-term clinical results of transurethral high-intensity directional ultrasound (HIDU) have been reported. With the resolution of some issues, HIDU may be commonly used for PC treatment similar to HIFU. Because HIFU and HIDU have limitations regarding the treatment of patients with large prostate calcifications and large prostate volumes, the proper use of these modalities will enable the treatment of any target area in the prostate. To establish a standard treatment strategy for localized PC, pair-matched and historically controlled studies are required to verify the oncological and functional outcomes of ultrasound treatment for patients with localized PC.
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Affiliation(s)
- Sunao Shoji
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Jun Naruse
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Kazuya Oda
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Satoshi Kuroda
- Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Tatsuya Umemoto
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Nobuyuki Nakajima
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masanori Hasegawa
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Anju Mukasa
- Department of Mechanical and Intelligent Systems Engineering, Graduate School of Informatics and Engineering, The University of Electro-Communications, Chofu, Tokyo, Japan
| | - Norihiro Koizumi
- Department of Mechanical and Intelligent Systems Engineering, Graduate School of Informatics and Engineering, The University of Electro-Communications, Chofu, Tokyo, Japan
| | - Akira Miyajima
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Azak C, Kavak G, Ertan F, Alioğlu F, Akkaş EA, Göksel F, Karakaya E. The effect of lower urinary tract substructure doses on side effects of cervical cancer image-guided adaptive brachytherapy. J Cancer Res Ther 2023; 19:1825-1830. [PMID: 38376285 DOI: 10.4103/jcrt.jcrt_2353_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/29/2022] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Image-Guided Adaptive Brachytherapy (IGABT) provides a survival advantage in locally advanced cervical cancer (LACC). Although side effects are seen less with this technique, dose parameters that cause urinary side effects are still questionable. We aim to investigate whether the radiotherapy doses of the lower urinary tract substructures (LUSS) affect the urinary system side effects (USSE) of cervical cancer external beam radiotherapy (EBRT) and the IGABT. METHODS LUSS (bladder, trigone, bladder neck, and urethra) doses were calculated in 40 patients diagnosed with LACC and receiving primary EBRT, IGABT, and concomitant chemotherapy. D0.1cc, D2cc, and D50% values were examined by contouring the bladder, trigone, bladder neck, and urethra from the intracavitary BT planning computed tomography (CT) images taken every 4 BT fractions, retrospectively. Besides, late USSE (urgency, dysuria (recurrent), frequency, obstruction, incontinence, hematuria, fistula, cystitis) were queried and categorized according to Common Toxicity Criteria for Adverse Events version 5.0. STATISTICAL ANALYSIS USED The Chi-square and Fisher's exact tests, Mann-Whitney U-test. RESULTS For the whole study population, for both incontinence and dysuria, trigone (D50%), urethra (D50%, D0.1cc,), and bladder neck (D50%, D0.1cc, D2cc) volume and hot spot doses remained significant. For cystitis, urethra (D50%, D0.1cc,) and bladder neck doses (D0.1cc, D50%, D2cc) are worth investigating. CONCLUSIONS Although USSE is less common in the intensity-modulated radiation therapy and IGABT era, it may be meaningful to take the doses of LUSS into account when planning IGABT. In addition, delineation of LUSS using only CT seems feasible. More proof is needed to determine delineation technique and dose constraints for LUSS for IGABT.
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Affiliation(s)
- Can Azak
- Department of Radiation Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Chen R, Song S, Amasyali AS, Leu R, Shete K, Ritchie C, Buell M, Baas C, Belle JD, Jhang D, Farkouh A, Baldwin DD. Does renal failure worsen radiation cystitis following radical prostatectomy? Int Urol Nephrol 2023; 55:2439-2445. [PMID: 37440005 DOI: 10.1007/s11255-023-03709-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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 34 months (interquartile range 16-65 months). 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). CONCLUSION 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.
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Affiliation(s)
- Ricky Chen
- Department of Urology, Loma Linda University Health, 11234 Anderson Street, Room A560, Loma Linda, CA, 92354, USA
| | - Sikai Song
- Department of Urology, Loma Linda University Health, 11234 Anderson Street, Room A560, Loma Linda, CA, 92354, USA
| | - Akin S Amasyali
- Department of Urology, Loma Linda University Health, 11234 Anderson Street, Room A560, Loma Linda, CA, 92354, USA
| | - Rose Leu
- Department of Urology, Loma Linda University Health, 11234 Anderson Street, Room A560, Loma Linda, CA, 92354, USA
| | - Kanha Shete
- Department of Urology, Loma Linda University Health, 11234 Anderson Street, Room A560, Loma Linda, CA, 92354, USA
| | - Cayde Ritchie
- Department of Urology, Loma Linda University Health, 11234 Anderson Street, Room A560, Loma Linda, CA, 92354, USA
| | - Matthew Buell
- Department of Urology, Loma Linda University Health, 11234 Anderson Street, Room A560, Loma Linda, CA, 92354, USA
| | - Catalina Baas
- Department of Urology, Loma Linda University Health, 11234 Anderson Street, Room A560, Loma Linda, CA, 92354, USA
| | - Joshua D Belle
- Department of Urology, Loma Linda University Health, 11234 Anderson Street, Room A560, Loma Linda, CA, 92354, USA
| | - Daniel Jhang
- Department of Urology, Loma Linda University Health, 11234 Anderson Street, Room A560, Loma Linda, CA, 92354, USA
| | - Ala'a Farkouh
- Department of Urology, Loma Linda University Health, 11234 Anderson Street, Room A560, Loma Linda, CA, 92354, USA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health, 11234 Anderson Street, Room A560, Loma Linda, CA, 92354, USA.
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Wang Y, Zhu Y, Xu X. Advances in the management of radiation-induced cystitis in patients with pelvic malignancies. Int J Radiat Biol 2023; 99:1307-1319. [PMID: 36940182 DOI: 10.1080/09553002.2023.2181996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Radiotherapy plays a vital role as a treatment for malignant pelvic tumors, in which the bladder represents a significant organ at risk involved during tumor radiotherapy. Exposing the bladder wall to high doses of ionizing radiation is unavoidable and will lead to radiation cystitis (RC) because of its central position in the pelvic cavity. Radiation cystitis will result in several complications (e.g. frequent micturition, urgent urination, and nocturia) that can significantly reduce the patient's quality of life and in very severe cases become life-threatening. METHODS Existing studies on the pathophysiology, prevention, and management of radiation-induced cystitis from January 1990 to December 2021 were reviewed. PubMed was used as the main search engine. Besides the reviewed studies, citations to those studies were also included. RESULTS AND DISCUSSIONS In this review, the symptoms of radiation cystitis and the mainstream grading scales employed in clinical situations are presented. Next, preclinical and clinical research on preventing and treating radiation cystitis are summarized, and an overview of currently available prevention and treatment strategies as guidelines for clinicians is provided. Treatment options involve symptomatic treatment, vascular interventional therapy, surgery, hyperbaric oxygen therapy (HBOT), bladder irrigation, and electrocoagulation. Prevention includes filling up the bladder to remove it from the radiation field and delivering radiation based on helical tomotherapy and CT-guided 3D intracavitary brachytherapy techniques.
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Affiliation(s)
- Yimin Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Zhu
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoting Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Wallace BK, Gillespie AM, Moran GW, Smigelski MB, Anderson CB. Heterogeneity in the pharmacological management of radiation-induced hemorrhagic cystitis. Urol Oncol 2022; 40:540.e11-540.e17. [PMID: 36229357 DOI: 10.1016/j.urolonc.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/28/2022] [Accepted: 09/11/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Radiation-induced hemorrhagic cystitis is a complication of pelvic radiotherapy, with an incidence of up to 5%. The resultant hematuria may be severe and refractory to conservative measures. Our objective was to describe the pattern of inpatient treatments among a cohort of patients with radiation-induced hemorrhagic cystitis requiring pharmacological management. METHODS We conducted a retrospective case series to identify all inpatient admissions at a single institution during which patients with radiation cystitis underwent pharmacological intervention for refractory hematuria between 2004 and 2019. Patient demographics, medical history, details of radiation therapy, and relevant admission data were collected. Details of treatment, including the use of pharmacotherapy and surgical treatment, were reviewed and summarized. RESULTS We identified 21 patients who were treated during 26 admissions. Most were male (91%) with a history of external beam radiation therapy (86%), primarily for prostate cancer (85%), and a median age of 73 (IQR: 67-85). Most patients received continuous bladder irrigation as the first intervention during their admission (65%), for a median duration of 40 hours (IQR: 25-59). Eleven separate pharmacologic agents were used, with variations in initial pharmacotherapy utilization over time. Most patients were treated with a combination of surgical and pharmacological interventions (85%). The median length of stay was 9 days (IQR: 5-17) and the 90-day readmission rate was 35%. CONCLUSIONS Pharmacologic treatment for refractory radiation-induced hemorrhagic cystitis is inconsistent and lacks evidence to support treatment strategies. Further work is needed to determine the optimal management for this morbid complication.
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Affiliation(s)
- Brendan K Wallace
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Anton M Gillespie
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - George W Moran
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Michael B Smigelski
- Department of Urology, Columbia University Irving Medical Center, New York, NY
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Sanguedolce F, Meneghetti I, Bevilacqua G, Montaño B, Martínez C, Territo A, Balaña J, Palou J, Breda A. Intravesical instillation with glycosaminoglycan replacement treatment in patients suffering radiation-induced haemorrhagic cystitis: When and which patients can benefit most from it? Urol Oncol 2022; 40:344.e19-344.e25. [DOI: 10.1016/j.urolonc.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022]
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Analysis of Clinicopathological Factors Associated with Radiation-Induced Cystitis in Patients with Cervical Cancer. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6216072. [PMID: 35911584 PMCID: PMC9325654 DOI: 10.1155/2022/6216072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Abstract
Objective To analyze the clinicopathological characteristics associated with radiation-induced cystitis (RIC) in patients with cervical cancer treated with chemoradiotherapy (CRT) alone or postoperational (post-op) CRT. Methods 107 patients with cervical cancer were retrospectively recruited into the study. The surgical status, FIGO staging, total and fractionated doses of radiotherapy (RT), and multiparameters including the dose, volume irradiated to the total bladder, and bladder wall were evaluated for RIC. The criteria on RIC were referred to CTCAE v5.0. Results Surgical operation and post-op CRT were delivered in 65 patients and CRT or RT alone in 42 patients. Among those with post-op CRT, 33/34 (97.06%), 22/43 (51.16%), and 10/30 (33.33%) patients were classified as FIGO stage I, II, and III/IV, respectively. The incidence of RIC was 30.84% for the whole group with 87.87% occurred in stage I and II patients. The incidence of CTCAE grade 2 and beyond was significantly higher in patients treated with post-op CRT than those with CRT alone (13.85% vs 2.38%, p = 0.043). Further analyses showed that the CTCAE level of RIC in the post-op CRT group was related to the relatively smaller average bladder volume (p = 0.029), whereas the difference in volume of bladder and bladder wall irradiated to 35.0 Gy or 40.0 Gy was not statistically significant between patients with or without RIC. Conclusion. The combination of surgery and post-op CRT may increase the incidence and severity of radiation-induced cystitis when compared to CRT alone, suggesting that bladder dysfunction associated with surgical procedure might increase the frequency and severity radiation related bladder toxicity. Further study is merited.
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12
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Addressing Common Pain Syndromes in Pediatric Stem Cell Transplant: A Review. CHILDREN 2022; 9:children9020139. [PMID: 35204860 PMCID: PMC8870628 DOI: 10.3390/children9020139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/08/2022] [Accepted: 01/13/2022] [Indexed: 11/25/2022]
Abstract
Assessment and management of pain for pediatric patients receiving stem cell transplants can be challenging for a health care team. Diagnostic evaluation and interventions vary between institutions and individual provider practices. In this review, we investigate and describe approaches to pain management for the most common sources of pain in pediatric patients undergoing stem cell transplants. Mucositis pain, abdominal pain, and hemorrhagic cystitis emerged as the most frequent sources of acute pain in children during conditioning and transplantation periods. Furthermore, psychosocial distress and psychological pain or distress constitute significant components of the total pain experienced by children undergoing stem cell transplantation. We will expand upon appropriate usage and escalation of opioids, as well as complementary interventions and timely initiation of interventions, in order to help control pain in these clinical syndromes.
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13
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Radiation Proctitis: The Potential Role of Hyaluronic Acid in the Prevention and Restoration of Any Damage to the Rectal Mucosa among Prostate Cancer Patients Submitted to Curative External Beam Radiotherapy. GASTROENTEROLOGY INSIGHTS 2021. [DOI: 10.3390/gastroent12040043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: To evaluate if hyaluronic acid reduces proctitis episodes with respect to corticosteroids in prostate cancer patients submitted to radical or adjuvant radiotherapy. Methods: A consecutive series of eligible patients received hyaluronic acid enemas as supportive care (experimental group, from January 2013 to June 2015). A historical group (control group), treated from October 2011 to December 2012, received beclomethasone dipropionate suppositories. We registered each patient’s data regarding acute and chronic proctitis. All patients were treated with static-intensity-modulated radiotherapy coupled to a daily set-up verification with orthogonal anterior–posterior/lateral X-ray pairs. Results: A total of 269 patients, 175 in the experimental group and 94 in the control group, was evaluated; 2 Gy/day (up to a total median dose of 80 Gy) and 2.7 Gy/day (up to a total median dose of 67.5 Gy) fractionation schemes were used for 216 and 53 patients, respectively. All patients had a good tolerance to radiotherapy, reporting no G3 or greater proctitis. No significant difference was reported concerning the total rate of proctitis between the two groups but only with respect to its grade: a higher G2 rate within the control group. There was no correlation between daily dose fractionation and toxicity grade. Conclusions: Hyaluronic acid enemas might be effective in reducing the severity of radiation proctitis.
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14
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Hoeh B, Müller SC, Kluth LA, Wenzel M. Management of Medium and Long Term Complications Following Prostate Cancer Treatment Resulting in Urinary Diversion - A Narrative Review. Front Surg 2021; 8:688394. [PMID: 34434956 PMCID: PMC8381645 DOI: 10.3389/fsurg.2021.688394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/09/2021] [Indexed: 12/24/2022] Open
Abstract
The purpose of this narrative review is to discuss and highlight recently published studies regarding the surgical management of patients suffering from prostate cancer treatment complications. Focus will be put on the recalcitrant and more complex cases which might lead to urinary diversion as a definite, last resort treatment. It is in the nature of every treatment, that complications will occur and be bothersome for both patients and physicians. A small percentage of patients following prostate cancer treatment (radical prostatectomy, radiation therapy, or other focal therapies) will suffer side effects and thus, will experience a loss of quality of life. These side effects can persist for months and even years. Often, conservative management strategies fail resulting in recalcitrant recurrences. Prostate cancer patients with "end-stage bladder," "devastated outlet," or a history of multiple failed interventions, are fortunately rare, but can be highly challenging for both patients and Urologists. In a state of multiple previous surgical procedures and an immense psychological strain for the patient, urinary diversion can offer a definite, last resort surgical solution for this small group of patients. Ideally, they should be transferred to centers with experience in this field and a careful patient selection is needed. As these cases are highly complex, a multidisciplinary approach is often necessary in order to guarantee an improvement of quality of life.
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Affiliation(s)
- Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Stefan C Müller
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
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15
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Urologic, lymphedema, pelvic pain and gastrointestinal symptoms increase after radiotherapy in patients with primary uterine tumors: a prospective longitudinal Swedish cohort study. Clin Transl Oncol 2021; 23:1752-1760. [PMID: 33686481 PMCID: PMC8310482 DOI: 10.1007/s12094-021-02576-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/18/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE Radiotherapy (RT) causes an inflammatory reaction of the tissue which leads to fibrosis and reduced functioning of the pelvic organs. Few studies have shown significant relationships between side effects and RT in uterine tumors. Here, the urological, lymphedema, pelvic pain and gastrointestinal (GI) symptoms were studied before and after RT in patients with primary uterine tumors using the EORTC QLQ-EN24, specifically designed for uterine cancer patients. METHODS This prospective cohort study comprised patients with primary uterine tumors who received pelvic radiotherapy (RT). A total of 43 patients were included from May 2014 to February 2019. Patients completed the questionnaires for global health status and functioning before the start of RT and at 3 and 12 months after RT. RESULTS We found a significant worsening of the urological symptoms 3 months after RT which persisted up to 12 months after RT compared to baseline values prior to start of RT (p = 0.007). An exacerbation of the urinary symptoms was seen in patients with vaginal brachytherapy/boost compared to patients with pelvic RT at 12 months after RT (p = 0.053). The severity of lymphedema symptoms increased from RT start to 12 months after RT (p = 0.019) and the pelvic pain were higher at 3 months after RT compared to before RT (p = 0.004). Also, the level of GI symptoms was significantly higher 12 months after RT compared to the RT start (p < 0.001). CONCLUSIONS The urologic, lymphedema, pelvic pain and GI symptoms all increase after RT.
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Shinde A, Li R, Han C, Frankel P, Sampath S. Dosimetric Predictors of Genitourinary Toxicity From a Phase I Trial of Prostate Bed Stereotactic Body Radiation Therapy. Pract Radiat Oncol 2020; 11:e90-e97. [PMID: 32562789 DOI: 10.1016/j.prro.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Our purpose was to analyze dose-volume parameters associated with genitourinary (GU) toxicity from a phase I clinical trial of prostate bed stereotactic body radiation therapy. METHODS AND MATERIALS Patients were treated in escalating dose levels of 35, 40, and 45 Gy, over 5 fractions. Data from all 26 patients enrolled in the protocol were analyzed using multiple dose-volume cut points for multiple GU organs at risk. Univariate logistical regression and Fisher exact test were used to assess statistical significance associated with incidence of toxicity. RESULTS The median follow-up was 36 months for all patients. Acute GU toxicity was mild and resolved spontaneously. Eight out of 26 patients (30.7%) developed late GU toxicity of grade 2 or higher. Two patients developed grade 3 ureteral stenosis, 1 in the 35 Gy arm and the other in the 45 Gy arm. Three patients developed grade 2 or higher hematuria/cystitis, and 3 developed grade 2 or higher incontinence. Incidence of grade 3 ureteral stenosis was related to the absolute volume of bladder wall receiving greater than 20, 25, and 30 Gy (P < .01). Grade 2 cystitis and hematuria were related to the volume of bladder wall receiving 20 Gy less than 34% and 35 Gy less than 25% (18.8% vs 60% and 23.8% vs 80%, respectively, P < .05). Incontinence was related to mean urethral dose less than 35 Gy and 25 Gy (4.3% vs 66.7% and 0% vs 37.5%, respectively, P < .05) and volume of urethra receiving 35 Gy less than 24% (8.3% vs 50%, P < .05). CONCLUSIONS This is the first analysis to report dose-volume thresholds associated with late GU toxicity in patients receiving prostate bed stereotactic body radiation therapy. We recommend limiting the bladder wall receiving 25 Gy to less than 18 cubic centimeters to reduce the risk for late grade 3 ureteral stenosis.
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Affiliation(s)
- Ashwin Shinde
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Richard Li
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Chunhui Han
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Paul Frankel
- Department of Biostatistics, City of Hope National Medical Center, Duarte, California
| | - Sagus Sampath
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California.
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Villeirs L, Tailly T, Ost P, Waterloos M, Decaestecker K, Fonteyne V, Van Praet C, Lumen N. Hyperbaric oxygen therapy for radiation cystitis after pelvic radiotherapy: Systematic review of the recent literature. Int J Urol 2019; 27:98-107. [PMID: 31617263 DOI: 10.1111/iju.14130] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 09/17/2019] [Indexed: 11/27/2022]
Abstract
The present study assessed the efficacy of hyperbaric oxygen therapy in reducing symptoms of radiation cystitis, a specific type of iatrogenic injury to the bladder, by systematic review of recent literature. The MEDLINE, Embase and Web of Science databases were searched using combinations of the terms "radiation," "cystitis" and "hyperbaric oxygen" to identify articles evaluating patients with radiation cystitis, treated with hyperbaric oxygen therapy. Only recent (≤10 years) original studies were included. Data were extracted and pooled in order to calculate descriptive weighted averages. Articles were evaluated on their level of evidence. A total of 20 papers were obtained, resulting in a cohort of 815 patients who were treated with hyperbaric oxygen therapy for radiation cystitis. Overall and complete response rates varied from 64.8% to 100% and 20% to 100%, respectively. The weighted average overall and complete response rates were 87.3% and 65.3%, respectively. Adverse events were observed in 9.6% of the patients, but permanent side-effects were rare. The most prominent limitations were high cost and low availability. Hyperbaric oxygen therapy is effective in the treatment of radiation-induced cystitis, with minimal adverse events, but low availability and high cost. At present, evidence is low; therefore, more prospective studies are required.
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Affiliation(s)
- Lauren Villeirs
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Thomas Tailly
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Piet Ost
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Marjan Waterloos
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Urology, Ghent University Hospital, Ghent, Belgium.,Department of Urology, General Hospital Maria Middelares, Ghent, Belgium
| | - Karel Decaestecker
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Valerie Fonteyne
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Charles Van Praet
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Nicolaas Lumen
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Urology, Ghent University Hospital, Ghent, Belgium
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18
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A contemporary review about the management of radiation-induced hemorrhagic cystitis. Curr Opin Support Palliat Care 2019; 12:344-350. [PMID: 30015689 DOI: 10.1097/spc.0000000000000375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There are various specific therapeutic intervention available to treat hemorrhagic cystitis, once emergency treatment has been carried out. The lack of prospective studies, because of the relative rarity of this condition, makes it difficult to hierarchize the therapeutic sequence. The present review presents and summarizes the literature published on radiation-induced hemorrhagic cystitis from April 2015, date of a precedent exhaustive review, to March 2018. RECENT FINDINGS During our period of interest, 13 clinical studies and two new clinical trials protocols were published. Most of the clinical studies were retrospective and presented data about hyperbaric oxygen (HBO) therapy, comforting its place as a well tolerated and effective first-line treatment. Other studies reported the outcomes of treatments with alum, formalin, silver nitrate, fulguration with laser or definitive surgery. SUMMARY Although authors seem to agree that formalin and surgery have their role as effective but potentially morbid last-line treatments, there is no consensus on primary approach to management of radiation-induced hemorrhagic cystitis beyond symptomatic measures. Several treatments have proven excellent response rates and few side effects. The results of on-going prospective studies on mesenchymal stromal cells or tacrolimus instillations are awaited, but the main discriminating factor to choose between treatments remains local availability.
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19
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Martin SE, Begun EM, Samir E, Azaiza MT, Allegro S, Abdelhady M. Incidence and Morbidity of Radiation-Induced Hemorrhagic Cystitis in Prostate Cancer. Urology 2019; 131:190-195. [PMID: 31201826 DOI: 10.1016/j.urology.2019.05.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/30/2019] [Accepted: 05/30/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine if reported incidence rates of hemorrhagic cystitis after radiation therapy for prostate cancer are accurate, to investigate the effect of different radiation modalities on the development of hemorrhagic cystitis and to assess its morbidity and treatment. MATERIALS AND METHODS A retrospective chart review was completed of 709 patients at 2 Detroit Medical Center hospitals who underwent radiation therapy for prostate cancer between January 2000 and September 2015. In patients who developed hemorrhagic cystitis, we analyzed the incidence, radiation modality, morbidity, treatment, and complications. RESULTS The incidence rate of hemorrhagic cystitis after radiation for prostate cancer was 11.1%. There was no significant difference between external beam and intensity-modulated radiation therapy and the development of hemorrhagic cystitis (P = .18). Patients developed hemorrhagic cystitis an average of 79.1 months (4-230 months) after radiation. The average number of admissions was 2.5 (1-9) with an average length of stay of 7.6 days (1-42 days). Fifty-two percent of patients required blood transfusion with an average of 4.3 units transfused per patient (1-33U). The most common treatment was cystoscopy with fulguration/clot evacuation in 86% of patients. Complications included urinary tract infection, acute kidney injury, urosepsis, and even death. CONCLUSION The incidence of hemorrhagic cystitis following radiation therapy for prostate cancer is under-reported in the literature. Hemorrhagic cystitis is associated with high morbidity and complications for patients, requiring multiple hospitalizations, blood transfusions, and procedures. Advances in radiation have not significantly reduced the risk of developing hemorrhagic cystitis.
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Affiliation(s)
- Sarah E Martin
- Detroit Medical Center, Department of Urology, Detroit, MI.
| | - Evan M Begun
- Detroit Medical Center, Department of Urology, Detroit, MI
| | | | | | - Steven Allegro
- Detroit Medical Center, Department of Urology, Detroit, MI
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20
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Goucher G, Saad F, Lukka H, Kapoor A. Canadian Urological Association Best Practice Report: Diagnosis and management of radiation-induced hemorrhagic cystitis. Can Urol Assoc J 2019; 13:15-23. [PMID: 30721124 PMCID: PMC6363576 DOI: 10.5489/cuaj.5788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- George Goucher
- Department of Surgery (Urology) and Oncology, McMaster University, Hamilton, ON, Canada
| | - Fred Saad
- Department of GU Oncology, l’Université de Montréal, Montreal, QC, Canada
| | - Himu Lukka
- Department of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Anil Kapoor
- Department of Surgery (Urology) and Oncology, McMaster University, Hamilton, ON, Canada
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21
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Cumulative incidence and predictive factors of radiation cystitis in patients with localized prostate cancer. Actas Urol Esp 2018; 42:256-261. [PMID: 29169704 DOI: 10.1016/j.acuro.2017.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the cumulative incidence of overall and severe radiation cystitis in a high volume cohort of patients and to investigate its potential predictive factors. METHODS We have performed a retrospective analysis of clinical data from patients diagnosed with localized prostate cancer and treated with radiotherapy at our institution (June 2005-January 2013), and quantified the cumulative incidence of radiation cystitis. Cox regression analysis and Kaplan-Meier curves were computed to evaluate the determinants of radiation cystitis. RESULTS Data from 783 patients was retrieved (557 treated with primary radiotherapy, 188 with adjuvant and 38 with salvage). Median follow-up time was 49 months (P25-P75: 31.8-69.3). At 5 years of follow-up, cumulative incidence of overall and severe radiation cystitis was 9.1 and 1.6%, respectively. No association was found between the incidence of radiation cystitis and age, tumor T stage, baseline PSA level, Gleason score, D'Amico risk classification, radiotherapy setting (primary versus adjuvant versus salvage) or radiation dose applied. CONCLUSIONS Within our cohort, radiation cystitis is an uncommon complication of prostatic radiotherapy treatment, and severe cases requiring hospitalization are even more infrequent. We found no association between tumor characteristics, radiotherapy setting or radiation dose and the cumulative incidence of radiation cystitis.
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Hacker KE, Reynolds RK, Uppal S. Ongoing strategies and updates on pain management in gynecologic oncology patients. Gynecol Oncol 2018; 149:410-419. [DOI: 10.1016/j.ygyno.2018.01.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/24/2018] [Accepted: 01/30/2018] [Indexed: 12/23/2022]
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Engle JA, Fair C. Sirolimus and mirabegron interaction in a hematopoietic cell transplant patient. J Oncol Pharm Pract 2017; 24:627-631. [PMID: 28814193 DOI: 10.1177/1078155217726161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Hematopoietic cell transplant patients are exposed to numerous classes of medications. Transplant practitioners must vigilantly monitor for drug interactions especially involving immunosuppressants. We report a hematopoietic cell transplant patient receiving sirolimus who developed supratherapeutic serum concentrations after initiating mirabegron. SUMMARY A 31-year-old, 98 kg female received a second umbilical cord blood transplant four years after the first transplant for relapsed acute myeloid leukemia. Mycophenolate mofetil and sirolimus were utilized for graft versus host disease prophylaxis. The patient was receiving sirolimus 2 mg daily and the serum concentration on day 26 post-transplant (day + 26) was within therapeutic range (6.7 μg/L, goal range 3-12 μg/L). Her post-transplant course was complicated by BK viruria-associated cystitis for which she was started on mirabegron. Six days after starting the new medication (day + 33), the sirolimus serum concentration increased to 19.2 μg/L. Thus mirabegron was discontinued and sirolimus was held. Sirolimus was restarted once the serum concentration was within goal and subsequently stabilized with a combination of 1 mg and 2 mg daily for a total weekly dose of 10 mg. The proposed mechanisms of interaction include: (1) sirolimus inhibition of organic anion transporting polypeptide leading to increased mirabegron in the intestinal lumen; (2) mirabegron inhibition of P-glycoprotein leading to increased absorption of sirolimus and; (3) increased sirolimus absorption leading to increased sirolimus serum concentrations. CONCLUSION To our knowledge, this is the first report of a potential drug interaction between sirolimus and mirabegron. Transplant specialists should be aware of this potential interaction when considering the concurrent use of these medications.
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Affiliation(s)
- Jeff A Engle
- Department of Pharmacy, University of Minnesota Medical Center, Minneapolis, USA
| | - Christina Fair
- Department of Pharmacy, University of Minnesota Medical Center, Minneapolis, USA
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24
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Treatment of Severe Refractory Hematuria due to Radiation-Induced Hemorrhagic Cystitis with Dexamethasone. Case Rep Med 2017; 2017:1560363. [PMID: 28713429 PMCID: PMC5497605 DOI: 10.1155/2017/1560363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/22/2017] [Indexed: 01/31/2023] Open
Abstract
Treatment of pelvic neoplasms with radiotherapy may develop sequelae, especially RHC. An 85-year-old male patient was admitted to a hospital emergency with gross hematuria leading to urinary retention and was diagnosed with RHC. The urinary bladder was probed, unobstructed, and maintained in continuous three-way saline irrigation. During 45 days of hospitalization, the patient underwent two cystoscopic procedures for urinary bladder flocculation, whole blood transfusions, and one platelet apheresis. None of these interventions led to clinical resolution. As the patient hematological condition was deteriorating, dexamethasone (4 mg i.v., bolus of 6/6, 12/12, and 24 h during five days) and epoetin alpha (1000 IU, 1 ml, s.c., for four weeks) were administered which led to the remission of the urinary bleeding. Dexamethasone therapy may be considered for RHC, when conventional treatments are not effective or are not possible, avoiding more aggressive interventions such as cystectomy.
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Abstract
Microscopic and gross hematuria present unique and difficult diagnostic and management challenges in the already complex general surgery patient. This article provides the general surgeon with relevant knowledge in the pathophysiology, anatomy, etiologies, workup, and treatments of hematuria. In addition common causes of hematuria that may be encountered by the general surgeon (including trauma, urinary tract infection, urolithiasis, and malignancy), the difficult to manage clinical situation of clot urinary retention is presented. This article provides a urologic framework of thinking for the clinician to best manage a general surgery patient who has hematuria.
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Affiliation(s)
- Gabriella J Avellino
- Department of Urology, Boston Medical Center, Boston University School of Medicine, 725 Albany Street, Suite 3B, Boston, MA 02118, USA
| | - Sanchita Bose
- Department of Urology, Boston Medical Center, Boston University School of Medicine, 725 Albany Street, Suite 3B, Boston, MA 02118, USA
| | - David S Wang
- Department of Urology, Boston Medical Center, Boston University School of Medicine, 725 Albany Street, Suite 3B, Boston, MA 02118, USA.
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Shi F, Wang T, Wang J, Hui B, Chai Y, Wang J, Liu Z. Peritoneal bladder fistula following radiotherapy for cervical cancer: A case report. Oncol Lett 2016; 12:2008-2010. [PMID: 27602129 DOI: 10.3892/ol.2016.4820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/12/2016] [Indexed: 02/04/2023] Open
Abstract
The occurrence of a peritoneal bladder fistula as a result of radiation cystitis following radiotherapy for cervical cancer is extremely rare and, to the best of our knowledge, has not been reported previously. The present study reports the case of a 50-year-old woman who was diagnosed with cervical cancer 20 years previously and was treated with radiotherapy. The patient was diagnosed with radiation cystitis 10 years ago, which was treated with Chinese medicine, and began experiencing sudden abdominal pain and bowel difficulties following urination 3 years ago. B-ultrasound examination at The People's Hospital of Tongchuan (Tongchuan, China) detected the presence of abdominal pelvic fluid. Following antibiotic (levofloxacin for 5 days) and ascites extraction treatment, symptoms were relieved without recurrence. However, 5 days prior to admission to the First Affiliated Hospital of Xi'an Jiatong University (Xi'an, China) on June 25, 2014, the patient experienced difficulty when urinating, abdominal pain and bloating, but did not experience frequent urination, hematuria or fever. Cystoscopic examination revealed a visible fistula on the bladder wall measuring 1×1 cm in diameter. Cytoscopic examination 1 month after catheterization and ascites extraction revealed no evidence of the fistula. The patient was followed up every 3 months for a year and a half, and is currently alive and well. In conclusion, the occurrence of peritoneal bladder fistula following radiation therapy is rare and cystoscopy is the preferred method of examination and diagnosis. Early detection and treatment may significantly improve the prognosis of patients.
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Affiliation(s)
- Fan Shi
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Tao Wang
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jiquan Wang
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Beina Hui
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yanlan Chai
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Juan Wang
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Zi Liu
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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Espenel S, Raffoux C, Vallard A, Garcia MA, Guy JB, Rancoule C, Ben Mrad M, Langrand-Escure J, Trone JC, Pigne G, Diao P, Magné N. Oxygénothérapie hyperbare et radiothérapie : entre mythe et réalité. Cancer Radiother 2016; 20:416-21. [DOI: 10.1016/j.canrad.2016.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/01/2016] [Indexed: 11/28/2022]
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Kilic O, Akand M, Karabagli P, Piskin MM. Hemostatic Efficacy and Histopathological Effects of Ankaferd Blood Stopper in an Experimental Rat Model of Cyclophosphamide-induced Hemorrhagic Cystitis. Urology 2016; 94:313.e7-313.e13. [PMID: 27215482 DOI: 10.1016/j.urology.2016.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 04/14/2016] [Accepted: 05/14/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the hemostatic efficacy and histopathological effects of Ankaferd Blood Stopper (ABS) in an experimental rat model of cyclophosphamide-induced (CYP) hemorrhagic cystitis (HC). MATERIALS AND METHODS Forty male Sprague-Dawley rats were included in the study. Firstly, 10 rats were divided equally into 2 groups where the first group was administered only an intraperitoneal (i.p.) injection of normal saline to constitute the negative control group (CON). The remaining 5 rats were administered only a single i.p. injection of CYP (without any further treatment) for induction of HC to constitute the positive control group (HC). Subsequently, the remaining 30 rats, which also received i.p. CYP for induction of HC, were divided into 3 groups to which intravesical saline (SAL group), epinephrine (EPN group), and ABS (ANK group) were administered for 3 consecutive days. Ten days after the third instillation, cystectomy was performed for histopathological examination. Specimens were evaluated for presence of congestion, edema, necrosis, ulceration, and regenerated epithelium, and scores were given for each parameter according to the severity. RESULTS No statistically significant difference was observed for congestion, edema, necrosis, and ulceration between HC-SAL, and also between CON-ANK groups (all P values >.05). There was a significant difference for total scores between EPN and ANK groups (P = .009). There was statistically significant difference for regenerating epithelium between CON-EPN, CON-ANK, HC-ANK, and SAL-ANK groups. CONCLUSION Intravesical administration of ABS is at least as efficacious as EPN in terms of congestion, edema, necrosis, and ulceration. Moreover, ABS can be considered as a better option in inducing regenerating epithelium than EPN.
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Affiliation(s)
- Ozcan Kilic
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Murat Akand
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey.
| | - Pinar Karabagli
- Department of Pathology, School of Medicine, Selcuk University, Konya, Turkey
| | - Mehmet Mesut Piskin
- Department of Urology, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
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