Non‐surgical interventions for late radiation cystitis in patients who have received radical radiotherapy to the pelvis Edited (no change to conclusions)

Abstract

Abstract Background

Chronic radiation cystitis occurs a minimum of three months after completion of pelvic radiotherapy and represents a range of clinical symptoms for which there is as yet no recommended standard management.

Objectives

The aim of this review was to identify the various non‐surgical treatment options for the management of late chronic radiation cystitis and evaluate the evidence.

Search methods

Synonyms for radiation therapy and for the spectrum of radiation toxicity to the bladder in both text and MeSH terms were combined and applied to a range of databases ‐ Cochrane Central Register of Controlled Trials (CENTRAL), Register 2001; MEDLINE 1966 to 2001; EMBASE 1980 to 2001; CANCERCD 1980 to 2001; Science Citation Index 1991 to 2001; CINAHL 1982 to 2001,and sources of grey literature. We also hand searched textbooks and contacted experts in the field. In the current update the search was updated to April 2007.

Selection criteria

Randomised controlled trials (RCTs), studies of interventions for the non‐surgical management of all grades of late radiation cystitis.

Data collection and analysis

Out of 85 relevant studies, there was one RCT that met the inclusion criteria and a prospective series (phase II study), both of these used the same intervention. In addition, there were three prospective case series and two non‐RCTs which assessed different interventions and were not comparable.

Main results

Sixty‐five reports met the stated inclusion criteria. The majority were predominantly retrospective case series with the exception of one RCT which used an agent called WF 10 (Veerasaran 2004), there were also two unrandomised and unblinded studies with a control group for comparison of effect, (Micic 1988), (intravesical placental extract) and (Milani 1988), (flavoxate). There is also a phase II series using WF 10 therapy.

Authors' conclusions

Late radiation cystitis is a relatively uncommon treatment complication and there are obvious difficulties in identifying sufficient patients to participate in a RCT. The number of published reports is a reflection of the degree of medical interest that exists in providing therapeutic solutions for late radiation cystitis. However, in spite of the two studies of level IIA evidence and the solitary RCT it is difficult to draw any firm conclusions.

Author(s)

Arshi S Denton, Noel Clarke, Jane Maher

Abstract

Plain language summary

Radiotherapy to the pelvis for cancer can damage the bladder in some, leading to late radiation cystitis

This can cause urinary problems including pain, blood in the urine and reduced bladder capacity. A cycle of bleeding, infection and occasionally life‐threatening complications can occur. Options include treating infections, blood transfusion, catheterisation, drugs inserted into the bladder, and surgery. This review found no evidence from trials to determine the effects of non‐surgical treatments for late radiation cystitis, although some drugs inserted into the bladder may be advantageous.

Author(s)

Arshi S Denton, Noel Clarke, Jane Maher

Reviewer's Conclusions

Authors' conclusions

Implications for practice

In a relatively rare condition there are obvious difficulties in identifying enough cases to participate in a randomised controlled trial. The number of published reports is a reflection of the degree of medical interest that exists in providing treatments for the managment of late radiation cystitis. Unfortunately the small numbers in the case series and methodology means that the data derived, despite the solitary RCT, is not enough to influence current trends in clinical practice other than that based on anecdotal and experiential knowledge. However they could form the basis of a multicentre randomised controlled trials to provide the evidence to subsequently implement changes and make recommendations. This would require a consensus of opinion from a multidisciplinary group of clinicians with experience in this field to decide on the specific characteristics for defining late radiation cystitis, the use of a universally accepted grading system and a hierarchy of the most effective treatment options from those listed in the review.

Implications for research

One way of increasing the number of cases with confirmed late radiation cystitis that may be suitable for treatment with the interventions outlined would be to create a database of such cases with central registration, uniform baseline assessments and formal standardised grading of the toxicity. In such a setting interventions could be administered in a multicentre trial so that small numbers of cases per centre could be pooled to provide results with consistently performed outcome assessments and significant clinical impact. Given the implications of late radiation toxicity this would be an ideal opportunity to collect parallel data regarding the effect that the treatment offered has on QOL issues but would require appropriate recognition, funding, manpower and commitment to institute this in practical terms.

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