What are the Significant Prognostic Factors to Predict the Outcome of Conservative (Nondiversion) Treatment in Patents with Cervical Cancer with Radiation Cystitis?
Keywords:
Hematuria, radiation cystitis, nondiversion, diversionAbstract
Background: Hematuria from radiotherapy to treat cervical cancer (CA CX) is a problem and a challenge in patient care for urologists. These patients have continued to suffer from pain, disease chronicity and other side effects of the radiotherapy. From past to present, the algorithm of treatment has focused on outcomes of numerous treatment modalities and described their characteristics, hemostatic mechanisms, advantages and disadvantages.
Objective: This study looks back to identify what patient-related factors were important and affected the success prognosis of the treatment, particularly of conservative (nondiversion) treatment.
Materials and Methods: It was a retrospective study, using data of patients in the Urology Unit of Lerdsin Hospital over15 years (October 2002 - September 2016). A total of 148 patients had complete data and were divided to 112 patients with conservative (nondiversion) treatment and 36 patients with diversion treatment. Eight patient factors were taken into the study as follows: bladder capacity, grade of telangiectasia, creatinine level, degree of hydronephrosis, urinary tract infection (UTI), severity of bleeding, age and medical illnesses(diabetes mellitus (DM) and/or hypertension (HT)).
Results: According to the statistical calculation in the study to compare each of the factors in both groups of the patients, namely with conservative (nondiversion) and diversion treatment, significant differences were found in all factors, except the age. In addition, multiple logistic regression analysis, which controlled the effects of other factors, found that factors that affected the treatment success (to stop bleeding) in patients with CA CX and radiation cystitis were bladder capacity, creatinine level and age. Patients with bladder capacities ≤ 150 ml were 18 times more likely to receive the diversion treatment when compared to those with the capacities > 150 ml. Patients with creatinine levels > 1.50 mg/dl were 61 times likely to receive the diversion treatment when compared to those with the levels ≤ 1.50. Patients aged > 55 years were 0.03 time more likely to receive the diversion treatment when compared to those aged ≤ 55 years.
Conclusion: These results may be applied by urologists to predict the success of conservative (nondiversion) treatment and help them make quicker decision in changing the treatment plan to the diversion treatment.
References
2. Levenback C, Eifel PJ, Burke TW, et al. Hemorrhagic cystitis following radiotherapy for stage Ib cancer of the cervix. Gynecol 1994; 55:206-10.
3. Capelli-Schellpfeffer M, Gerber G. The use of hyperbaric oxygen in urology. JUrol 1999; 162:647-54.
4. Zwaans BM, Chancellor MB, Lamb LE. Modelling and treatment of radiation cystitis. Urology 2016;88:14-21.
5. LiemX,Saad F, Delouya G. A Practical approach to the management of radiation-induced hemorrhagic cystitis. Drugs 2015;75:1471-82.
6. Alesawi AM, El-Hakim A, Zorn KC, Saad F. Radiation-induced hemorrhagic cystitis. Curr Opin Support Palliat Care 2014; 8:235-40.
7. Hamilton K, Bennett NC, Purdie G, Herst PM. Standardized cranberry capsules for radiation cystitis in prostate cancer patients in New Zealand: a randomizeddouble blinded, placebo controlled pilot study. Support Care Cancer 2015;23:95-102.
8. Liu YK, Harty JI, Steinbock GS, Holt HA, Goldstein DH, Amin M. Treatment of radiation or cyclophosphamide induced hemorrhagic cystitis using conjugatedestrogen. J Urol 1990;144:41-3.
9. Hampson SJ, Woodhouse CR. Sodiumpentosanpolysulphate in the managementof haemorrhagic cystitis: experience with 14 patients. EurUrol 1994;25:40-2.
10. Sandhu SS, Goldstraw M, Woodhouse CR. The management of haemorrhagiccystitis with sodium pentosanpolysulphate. BJU Int 2004;94:845-7.
11. Veerasarn V, Boonnuch W, Kakanapon C. A phase II study to evaluate WF10 inpatients with late hemorrhagic radiation cystitis and proctitis. Gynecology 2006;100:179-84.
12. Connollt SS, D’Arcy FT, Corcoram MO. Recombinant activated factor VII tocontrol life-threatening haemorrhagic radiation cystitis. Ir J Med Sci 2010;179:431-3.
13. Sommariva ML, Sandri SD, Ceriani V. Efficacy of sodium hyaluronate in themanagement of chemical and radiation cystitis. Minerva Urol Nefrol 2010;62:145-50.
14. Shao Y, Lu G, Shen Z. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis. BJU Int 2012;109:691-4.
15. Smit SG, Heyns CF. Management of radiation cystitis. Nat Rev Urol 2010;7:206-14.
16. Hazewinkel MH, Stalpers LJA, Dijkgraaf MG, Roovers JPWR. Prophylactic vesical instillations with 0.2% chondroitin sulfate may reduce symptoms of acuteradiation cystitis in patients undergoing radiotherapy for gynecological malignancies. Int Urogynecol J 2011;22:725-30.
17. Ravi R. Endoscopic neodymium: YAG laser treatment of radiation-induced hemorrhagic cystitis. Lasers Surg Med 1994;14:83-7.
18. Zhu J, Xue B, Shan Y, Yang D, Zang Y. Transurethral coagulation for radiation-induced hemorrhagic cystitis using Green-light TMpotassium-titanyl-phosphatelaser. Photomed Laser Surg 2013;31:78-81.
19. Pasquier D, Hoelscher T, Schmutz J, et al. Hyperbaric oxygen therapy in the treatment of radio-induced lesions in normal tissues: a literature review. Radiother Oncol 2004;72:1-13.
20. Loffory R, Pottecher P, Cherblane V, et al. Role actuel de l’ embolisationarterielletran-scatheterdans le traitement deshemorragiesvsicales et prosta-tiques. J Radiol Diagn Interv 2014;95:1017-24.
21. Zagoria RJ. Hodge RG, Dyer RB, Routh WD. Percutaneous nephrostomy for treatment of intractable hemorrhagic cystitis. J Urol 1993;149:1449-51.
22. Ravi R, Dewan AK, Pandey KK. Transverse colon conduit urinary diversion inpatients treated with very high dose pelvic irradiation. Br J Urol 1994;73:51-4.
23. Alkan I, Jeschke S, Leeb K, Albquami N, Janetschek G. Treatment of radiation-induced hemorrhagic laparoscopic cystoprostatectomy. Urol Int 2006;77:190-2.
24. Singh I, Laungani GB. Intravesical epsilon aminocaproic acid in the management of intractable bladder hemorrhage. Urology 1992;40:227-9.
25. Choong SK, Walkden M, Kirby R. The management of intractable hematuria. BJU Int 2000;86:951-9.
26. Ragavaiah NV, Soloway MS. Anuria following silver nitrate irrigations for intractable bladder hemorrhage. J Urol 1977; 118:681-2.
27. Lebowitz RL. Intravesical chemical cauterization and methemoglobinemia. Pediatrics 1980;65:630.
28. Sarnak MJ, Long J, King AJ. Intravesicular formaldehyde instillation and renal complications. Clin Nephrol 1999;51: 122-5.
29. Cox PJ. Cyclophosphamide cystitis: identification of acrolein as the causative agent BiochemPharmacol 1979;28:2045-9.
30. Heath JA, Mishra S, Mitchell S, Waters KD, Tiedemann K. Estrogen as treatment of hemorrhagic cystitisin children and adolescents undergoing bone marrow transplantation. Bone Marrow Transplant 2006;37:523-6.
31. Veerasaen V, Boonnuch W, Kakanaporn C. A Phase II study to evaluate WF10 inpatients with late hemorrhagic radiation cystitis and proctitis. GynecolOncol 2006;100:179-84.
32. Ippoliti C, Przepiorka D, Mehra R, et al. Intrevesicularcarboprost for the treatment of hemorrhagic cystitis after marrow transplantation. Urology 1995;46:811-5.
33. Ouwenga MK, Langston MD, Campbell SC. Use of fibrin sealant in recalcitrant hemorrhagic cystitis. J Urol 2004;172: 1348.
34. Suzuki S, Chino A, Fukui L, et al. Successful use of endoscopic argon plasmacoagulation for hemorrhagic radiation cystitis: a case report. Jpn J Clin Oncol 2014;44:692-5.
35. Zhu J, Xue B, Shan Y, Yang D, Zang Y. Transurethral coagulation for radiation-induceshemorrhagic cystitis using GreenlightTM potassium-titanyl-phosphate laser. Photomed Laser Surg 2013;31:78-81.
36. DeVries CR, Freiha FS. Hemorrhagic cystitis: a review. J Urol 1990;143:1-9.
37. Lawton CA, Wong M, Pilepich MW, et al. Long-term sequelae following external beam irradiation for adenocarcinoma of the prostate: analysis of RTOG studies 7506 and 7706. Int J Radiat Oncol Biol Phys 1991;21:935-9.
Downloads
Published
How to Cite
Issue
Section
License
Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.
