Sequelae of treatment in 109 patients followed for 5 to 15 years after diagnosis of sarcoma of the bladder and prostate. A report from the intergroup rhabdomyosarcoma study committee

Abstract

Background. As increasing numbers of young patients with cancer survive, interest in the late effects of therapy is rising. Methods. The sequelae of treatment were reviewed after a minimum of 5 years of observation in 109 surviving patients with sarcoma of the bladder or prostate who were enrolled in the Intergroup Rhabdomyosarcoma Studies I and II (1972–1984). The 82 male and 27 female patients were 3 weeks to 19 years of age when the diagnosis was made (median, 2 years) and were 5–29 years of age at last contact (median, 11 years). Treatment consisted of chemotherapy with vincristine, dactinomycin, and cyclophosphamide and bladder irradiation in nearly all patients. Results. Fifty‐four patients underwent total cystectomy, and 10 had a partial cystectomy. Of the 55 patients with bladder preservation, 1 had a urinary conduit with a nonfunctioning bladder. Thus, 54 bladders (50% of the total) remained in place as part of the urinary tract. There was no information regarding bladder function in two patients. Satisfactory bladder function was found in 38 patients (73%), 9 were incontinent, and 5 had urinary frequency with or without nocturia. Posttherapy hematuria was detected in 29% of patients. Nine of the 31 patients (29%) with follow‐up renal imaging studies had a structural abnormality, chiefly hydronephrosis, which was more frequent in those with urinary diversion. Positive urine cultures were found mainly among those with enteric urinary conduits, but only two cases of pyelonephritis were documented. Abnormalities of irradiated bone and bowel were observed infrequently. Only one patient had a significantly elevated blood urea nitrogen or serum creatinine value, and only one patient was hypertensive. Most patients were still prepubertal at last follow‐up. Of 24 patients who were intrapubertal or postpubertal, 7 (29%) were receiving sex hormone replacement because of delayed pubertal development. Height was decreased by 25% or more in 11 patients, as confirmed by growth chart analysis. Secondary surgical procedures other than repeat biopsy or cystectomy consisted primarily of urinary conduit revisions and repair of bowel adhesions or fistulous tracts. Information about psychosocial status was limited. Conclusions. Overall, 50% of the patients retained their bladders, and 73% of them had satisfactory bladder function. Renal function was preserved in nearly every patient.

Childhood cancer survivors: Considerations for surgeons in the transition from pediatric to adult care

“…A study of survivors of bladder and prostate sarcomas similarly demonstrated that when adhesions did occur, they tended to be early complications. 12 Bowel obstructions are also well documented after staging laparotomy or splenectomy for Hodgkin lymphoma (HL), although these surgeries are no longer routine elements of HL care. 13,14 Bowel obstruction risk is further increased in patients who receive abdominal RT, which has been associated with chronic enterocolitis 15 and strictures.…”

Risk-based health monitoring of childhood cancer survivors: A report from the children’s oncology group

“…Esophageal strictures have been described in survivors of mediastinal lymphoma who have undergone radiotherapy, but this complication is rare with contemporary low-dose therapy [35]. In survivors of abdominal sarcomas treated with combined modalities, including radiation (doses > 30 Gy) of the gastrointestinal tract, fibrosis and inflammation may cause partial or complete bowel obstruction, ulcers, fistulae, chronic enterocolitis, or incontinence [36].…”

Treatment modalities of bladder/prostate rhabdomyosarcoma: a review

“…In IRS I, 35 of the 80 patients with B/P RMS underwent radical surgery incorporating a total cystectomy often via anterior pelvic exenteration before initiating CTX. 26 Radical surgery was considered the conventional approach by most at that time. 27,28 These patients were then staged in clinical groups I and II.…”