Prophylactic vesical instillations with 0.2% chondroitin sulfate may reduce symptoms of acute radiation cystitis in patients undergoing radiotherapy for gynecological malignancies

Hazewinkel, Menke H.; Stalpers, Lukas J.A.; Dijkgraaf, Marcel G. W.; Roovers, Jan‐Paul W. R.

doi:10.1007/s00192-010-1357-0

Cited by 46 publications

(29 citation statements)

References 14 publications

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“…The majority of the selected publications referred to BPS/ IC therapy, except for 2 papers on ChS 0.2 %, which evaluated the product in patients with overactive bladder [25,26] and for the prophylaxis of radiation cystitis [27]; 2 of the excluded articles reported on the efficacy of a combination of heparin and lidocaine as an acute analgesic intervention for severe pain [28,29].…”

Section: Resultsmentioning

confidence: 99%

“…They concluded that ChS is superior to other intravesical GAG substitutes. However, in their review, 368 patients who were treated with ChS had a diagnosis of OAB, 20 patients a diagnosis of radiation cystitis [27], and only 118 patients were Bexclusively^diagnosed with BPS/IC. The authors also state that no significant superiority versus controls was observed in the single controlled study on ChS 2 % that was reviewed [35].…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Review and Meta-analysis on the Efficacy of Intravesical Therapy for Bladder Pain Syndrome/Interstitial Cystitis

Barua

Arance

Angulo

et al. 2016

Obstetrical &Amp; Gynecological Survey

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Bladder pain syndrome/interstitial cystitis (BPS/ IC) is a chronic disease characterised by persistent irritating micturition symptoms and pain. The objective was to compare the clinical efficacy of currently available products for intravesical therapy of BPS/IC and to assess their pharmacoeconomic impact. A Pubmed/Medline database search was performed for articles on intravesical therapy for BPS/IC. A total of 345 publications were identified, from which 326 were excluded. Statistical evaluation was performed with effect size (ES) assessment of symptom reduction and response rates. The final set of 19 articles on intravesical BPS/IC therapy included 5 prospective controlled trials (CTs), the remaining were classified as uncontrolled clinical studies. The total number of patients included was 801, 228 of whom had been evaluated in a CT. For CTs, the largest ES for symptom reduction as well as response rate was observed for high molecular weight hyaluronic acid (HMW-HA), with similar findings in two uncontrolled studies with HMW-HA. The number needed to treat to achieve a response to intravesical therapy was 2.67 for intravesical pentosan polysulphate and 1.31 for HMW-HA which were superior to all other instillates.HMW-HA was significantly superior in cost effectiveness and cost efficacy to all other instillation regimes. The present meta-analysis combined medical and pharmacoeconomic aspects and demonstrated an advantage of HMW-HA over other instillation agents; however, direct comparisons between the different products have not been performed to date in properly designed controlled studies.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-analysis on the Efficacy of Intravesical Therapy for Bladder Pain Syndrome/Interstitial Cystitis

Barua

Arance

Angulo

et al. 2016

Obstetrical &Amp; Gynecological Survey

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“…Chondroitin sulfate has been validated in interstitial cystitis patients [50], and in a pilot study [51] to prevent radiation cystitis. Twenty patients with endometrial or cervical cancers were included in the study-ten were treated with 40 mL of 0.2 % solution of chondroitin sulfate weekly instillations and ten in the control group received no treatment.…”

Section: Other Agentsmentioning

confidence: 99%

A Practical Approach to the Management of Radiation-Induced Hemorrhagic Cystitis

Liem

Saad

Delouya

2015

Drugs

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Radiation-induced hemorrhagic cystitis (HC) is a complication of pelvic radiotherapy, mainly for prostate and uterine cancers. In the acute phase, patients feel urinary urgency and bladder pain. This phase is reversible after radiotherapy. In the chronic stage, an irritative syndrome is coupled with hematuria during the 2-10 years following radiotherapy. Cystoscopy shows white and frosted mucosa with telangiectasia. The incidence is estimated at 5 % or less. It is suggested that the radiation oncologist reviews the dosimetry plan to validate that the lesions coincide with significant radiation exposure confirming diagnosis of radiation-induced HC. The treatment for HC is first symptomatic, with bladder lavage, clot evacuation, coagulation via cystoscopy and blood transfusions if necessary. Subsequently, hyaluronic acid bladder instillation can be done with little toxicity. Hyperbaric oxygen therapy delivers pure oxygen to patients in a pressurized cabin, promoting angio-neogenesis and lowering hypoxia to the irradiated tissues. The clinical response rate is estimated to be around 80 %. Nevertheless, this approach is limited by the low availability, and length of treatment. While surgery remains an effective treatment for HC, it is the last option because of the high morbidity and mortality risks. Prospective studies need to be conducted to identify and evaluate new interventions, particularly for HC.

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“…A comparative pilot study in 20 patients planned for primary or adjuvant radiotherapy for endometrial or cervical cancer examined the feasibility and efficacy of intravesical instillations with 40 mL chondroitin sulfate (0.2%) solution in preventing or reducing acute radiation cystitis . Ten patients consented for weekly bladder instillations for the duration of radiation therapy while the remaining 10 did not opt for intravesical treatment and served as controls.…”

Section: Experimental Modalitiesmentioning

confidence: 99%

Advances in Therapeutic Development for Radiation Cystitis

Rajaganapathy

Nirmal

Tyagi

et al. 2013

LUTS

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Radiation treatment for pelvic malignancies is typically associated with radiation injury to urinary bladder that can ultimately lead to radiation cystitis (RC). The late sequelae of radiation therapy may take many years to develop and include bothersome storage symptoms such as hematuria, which may be life‐threatening in severe cases of hemorrhagic cystitis. Although no definitive treatment is currently available, various interventions are used for radiation and hemorrhagic cystitis including blood transfusion, bladder irrigation, intravesical instillation of substances such as alum, silver nitrate, prostaglandins or formalin, and fulguration of intravesical bleeding sites and surgery options such as supravesical urinary diversions and cystectomy. Effects of non‐surgical treatments for radiation and hemorrhagic cystitis are of modest success and studies are lacking to control the effects caused by RC. When such measures have proven ineffective, use of bladder botulinum toxin injection has been reported. New therapy, such as intravesical immunosuppression with local tacrolimus formulation is being developed for the treatment of radiation hemorrhagic cystitis.

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Prophylactic vesical instillations with 0.2% chondroitin sulfate may reduce symptoms of acute radiation cystitis in patients undergoing radiotherapy for gynecological malignancies

Cited by 46 publications

References 14 publications

A Systematic Review and Meta-analysis on the Efficacy of Intravesical Therapy for Bladder Pain Syndrome/Interstitial Cystitis

A Systematic Review and Meta-analysis on the Efficacy of Intravesical Therapy for Bladder Pain Syndrome/Interstitial Cystitis

A Practical Approach to the Management of Radiation-Induced Hemorrhagic Cystitis

Advances in Therapeutic Development for Radiation Cystitis

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