The clinical research of 5 steps sequential method for whole treatment of hemorrhagic radiation cystitis in china

Safety and efficacy of non-surgical treatments for chronic post-radiation cystitis: a systematic review

Introduction

Post-radiation cystitis is a complication of external beam radiation therapy, for the radical treatment of pelvic malignancies as radical treatment for pelvic malignancies. Chronic, refractory, post-radiation cystitis is problematic in its management, mainly when a conservative approach is preferred. Conservative methods are the first line of treatment, especially since the area has been irradiated, making surgical treatment more challenging.The objective of this systematic review is to evaluate the effectiveness and safety of conservative methods for the management of post-radiation cystitis. All non-invasive methods were included in the research, in patients over 18 years of age undergoing pelvic radiation therapy.

Material and methods

We conducted a systematic search for comparable studies on the conservative treatment of chronic post-radiation cystitis, analysing the efficacy and safety of these techniques, based on a specific protocol. The PubMed, Scopus, and CENTRAL databases and the grey literature were searched. Risk control of the individual papers was carried out using the RoB2 and ROBINS-I tools.

Results

A total of 282 papers were reviewed, of which 6 were included in the review: 3 randomised clinical trials and 3 non-randomised studies. Each of these studies investigated a different treatment, using a different population as control group, so it was not possible to conduct a meta-analysis of the studies.

Conclusions

Although most conservative measures appear to be successful in the management of post-radiation cystitis, more studies, especially randomised clinical trials, are needed before an algorithm of conservative methods can be created.

Advances in the management of radiation-induced cystitis in patients with pelvic malignancies

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.

Current management of radiation cystitis after pelvic radiotherapy: a systematic review

INTRODUCTION

We aimed to summarize current literature about radiation cystitis treatments, providing physician of a summary of current management options.

EVIDENCE ACQUISITION

A systematic literature review searching on PubMed (Medline), Scopus, and Web of Science databases was performed in March 2021. PRISMA guidelines were followed. Population consisted of patients with a diagnosis of radiation cystitis after pelvic radiotherapy (P). We focused our attention on different treatments, such as conservative or surgical one (I). Single or multiple arms studies were deemed eligible with no mandatory comparison (C). Main outcomes of interest were symptoms control and adverse events rates (O).

EVIDENCE SYNTHESIS

The search identified 1,194 records. Of all, four studies focused on the use of hyperbaric oxygen therapy showing complete response rates ranging from 52 to 87% approximately. Oral administration of cranberry compounds was investigated in one study showing no superiority to placebo. Intravesical instillation of different compounds were investigated in five studies showing the highest complete response rates after alum (60%) and formalin administration (75%). Endoscopic conservative surgical treatments (fibrin glue or vaporization) also showed 75% complete response rates. In patients who did not respond to conservative treatments robotic cystectomy is feasible with overall complication rates of about 59.3% at 90 days.

CONCLUSIONS

Radiotherapy induced cystitis is an under-reported condition after pelvic radiotherapy. Several treatments have been proposed, but in up to 10% of cases salvage cystectomy is necessary. A stepwise approach, with progressive treatment aggressiveness is recommended.