Radiation Induced Cystitis and Proctitis - Prediction, Assessment and Management

Abstract

Cystitis and proctitis are defined as inflammation of bladder and rectum respectively. Haemorrhagic cystitis is the most severe clinical manifestation of radiation and chemical cystitis. Radiation proctitis and cystitis are major complications following radiotherapy. Prevention of radiation-induced haemorrhagic cystitis has been investigated using various oral agents with minimal benefit. Bladder irrigation remains the most frequently adopted modality followed by intra-vesical instillation of alum or formalin. In intractable cases, surgical intervention is required in the form of diversion ureterostomy or cystectomy. Proctitis is more common in even low dose ranges but is self-limiting and improves on treatment interruption. However, treatment of radiation proctitis is broadly non-invasive or invasive. Non-invasive treatment consists of non-steroid anti-inflammatory drugs (NSAIDs), anti-oxidants, sucralfate, short chain fatty acids and hyperbaric oxygen. Invasive treatment consists of ablative procedures like formalin application, endoscopic YAG laser coagulation or argon plasma coagulation and surgery as a last resort.

Novel and Effective Almagate Enema for Hemorrhagic Chronic Radiation Proctitis and Risk Factors for Fistula Development

“…Mild or transient bleeding can experience a spontaneous remission requiring non-specific treatment. Moderate to severe bleeding can progress to severe anemia and threaten lives (Cho et al, 1995;Mallick et al, 2015). Therefore, controlling bleeding by medical agents like almagate and sulcrafate, or other aggressive treatments like endoscopic APC and topical formalin, are very essential for patients to help to safely get through this tough period of bleeding.…”

Quality of life after external beam radiotherapy for localized prostate cancer: Comparison with other modalities

“…These side‐effects are frequently observed in clinical practice as a typical course of symptoms after EBRT. The management of the side‐effects was summarized in previous literature, and evidence has been accumulated regarding patients’ QOL after EBRT compared with other modalities …”

Hyperbaric oxygen therapy for radiation cystitis after pelvic radiotherapy: Systematic review of the recent literature

“…Available options at present include bladder irrigation (with saline or specific solutions, such as alum, silver nitrate, formalin or hyaluronic acid), coagulation or selective embolization of bleeding vessels and HBOT . However, these modalities are not always successful, and in severe intractable radiation cystitis, radical cystectomy is the only remaining option …”

“…This is achieved through induction of neovascularization, and therefore angiogenesis and granulation tissue formation, fibroblast proliferation, and optimization of the cellular immune functions. Disadvantages of HBOT include claustrophobia during therapy, and logistic difficulties, as the patient needs to go to the center with pressurized chambers daily …”

“…2 However, these modalities are not always successful, and in severe intractable radiation cystitis, radical cystectomy is the only remaining option. 3 In HBOT, 100% oxygen is administered in a highly pressurized chamber (usually~2 atmospheres) for 5-7 days a week, for a daily duration of 60-90 min up to approximately 30-45 sessions. The aim of HBOT is to reverse the process of radiation-induced cellular hypoxia in the bladder tissue through better diffusion of oxygen within the tissues.…”