Clinical Guidelines for the Prevention and Treatment of Radiation-induced Bladder Injury

Abstract

Radiation-induced bladder injury is a common complication after pelvic radiotherapy. Few studies exist on diagnosing and treating radiation-induced bladder injury, with no established guidelines or consensus in China or internationally. Clinical physicians' diagnosis and treatment of radiation-induced bladder injury are primarily based on their own clinical experience, and there is an urgent need for unified guidelines to standardize clinical diagnosis and treatment. Therefore, the Chinese Radiation Therapy Oncology Group, China Anti-Cancer Association Tumor Support Therapy Committee, and China Anti-Cancer Association Tumor Radiation Protection Committee gathered experts to develop Chinese clinical practice guidelines, guiding diagnosing and treating radiation-induced bladder injury. The development of these guidelines adopted the grading system of evidence quality and recommendation strength (GRADE).

Keywords

Clinical practice guidelines / Radiation-induced bladder injury / Radiation cystitis / Treatment

References

[1] GuyattG, OxmanAD, AklEA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383-394.

[2] FrancoliniG, DettiB, BecheriniC, et al. Toxicity after moderately hypofractionated versus conventionally fractionated prostate radiotherapy: a systematic review and meta-analysis of the current literature. Crit Rev Oncol Hematol. 2021;165:103432

[3] KerkmeijerLGW, GroenVH, PosFJ, et al. Focal boost to the intraprostatic tumor in external beam radiotherapy for patients with localized prostate cancer: results from the FLAME randomized phase III trial. J Clin Oncol. 2021;39(7):787–796.

[4] Di FrancoR, Borzillo V, RavoV, et al. Rectal/urinary toxicity after hypofractionated vs. conventional radiotherapy in high risk prostate cancer: systematic review and meta analysis. Eur Rev Med Pharmacol Sci. 2017;21(16):3563–3575.

[5] KirwanJM, Symonds P, GreenJA, et al. A systematic review of acute and late toxicity of concomitant chemoradiation for cervical cancer. Radiat Oncol. 2003;68(3):217–226.

[6] GilbertA, Ziegler L, MartlandM, et al. Systematic review of radiation therapy toxicity reporting in randomized controlled trials of rectal cancer: a comparison of patient-reported outcomes and clinician toxicity reporting. Int J Radiat Oncol Biol Phys. 2015;92(3):555–567.

[7] MaduroJH, PrasE, WillemsePH, et al. Acute and long-term toxicity following radiotherapy alone or in combination with chemotherapy for locally advanced cervical cancer. Cancer Treat Rev. 2003;29(6):471–488.

[8] PotterR, Tanderup K, SchmidMP, et al. MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study. Lancet Oncol. 2021;22(4):538–547.

[9] BrossardC, Lefranc AC, SimonJM, et al. Understanding molecular mechanisms and identifying key processes in chronic radiation cystitis. Int J Mol Sci. 2022;23(3):1836.

[10] JaalJ, DorrW. Radiation-induced damage to mouse urothelial barrier. Radiat Oncol. 2006;80(2):250–256.

[11] El-BenhawySA, SadekNA, KamelMM, et al. Study the relationship of endothelial damage /dysfunction due to occupational exposure to low dose ionizing radiation versus high dose exposure during radiotherapy. Cancer Treat Res Commun. 2020;25:100215.

[12] HelisseyC, Cavallero S, BrossardC, DusaudM, Chargari C, FrançoisS. Chronic Inflammation and Radiation-Induced Cystitis: Molecular Background and Therapeutic Perspectives. Cells. 2020;10(1):21. ???Published 2020 Dec 24.

[13] JaalJ, Bruchner K, HoinkisC, et al. Radiation-induced variations in urothelial expression of intercellular adhesion molecule 1 (ICAM-1): association with changes in urinary bladder function. Int J Radiat Biol. 2004;80(1):65–72.

[14] JaalJ, DorrW. Radiation induced inflammatory changes in the mouse bladder: the role of cyclooxygenase-2. J Urol. 2006;175(4):1529–1533.

[15] ZwaansBM, Nicolai HG, ChancellorMB, et al. Challenges and opportunities in radiation-induced hemorrhagic cystitis. Rev Urol. 2016;18(2):57–65.

[16] CoxJD, StetzJ, PajakTF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer(EORTC). Int J Radiat Oncol Biol Phys. 1995;31(5):1341–1346.

[17] HarsoliaA, VargasC, YanD, et al. Predictors for chronic urinary toxicity after the treatment of prostate cancer with adaptive three-dimensional conformal radiotherapy: dose-volume analysis of a phase II dose-escalation study. Int J Radiat Oncol Biol Phys. 2007;69(4):1100–1109.

[18] InokuchiH, Mizowaki T, NorihisaY, et al. Correlation between urinary dose and delayed radiation cystitis after 78 Gy intensity-modulated radiotherapy for high-risk prostate cancer: a 10-year follow-up study of genitourinary toxicity in clinical practice. Clin Transl Rad Oncol. 2017;6:31–36.

[19] MichalskiJM, YanY, Watkins-BrunerD, et al. Preliminary toxicity analysis of 3-dimensional conformal radiation therapy versus intensity modulated radiation therapy on the high-dose arm of the Radiation Therapy Oncology Group 0126 prostate cancer trial. Int J Radiat Oncol Biol Phys. 2013;87(5):932–938.

[20] EifelPJ, Jhingran A, BodurkaDC, et al. Correlation of smoking history and other patient characteristics with major complications of pelvic radiation therapy for cervical cancer. J Clin Oncol. 2002,20(17):3651–3657.

[21] ViswanathanAN, YorkeED, MarksLB, et al. Radiation dose-volume effects of the urinary bladder. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):116-122.

[22] VannesteBGL, Van Limbergen EJ, MarcelissenTA, et al. Development of a management algorithm for acute and chronic radiation urethritis and cystitis. Urol Int. 2022;106(1):63–74.

[23] PayneH, Adamson A, BahlA, et al. Chemical-and radiation-induced haemorrhagic cystitis: current treatments and challenges. BJU Int. 2013;112(7):885–897.

[24] ChenY, WangY, KongF, et al. CBCT was used to analyze the positioning error of radiotherapy for 50 cases of pelvic malignant tumor [J. Chin J Cancer Prev Treat. 2019;26(18):1382–1386.

[25] ArbeaL, RamosLI, Martinez-MongeR, et al. Intensity-modulated radiation therapy (IMRT) vs. 3D conformal radiotherapy (3DCRT) in locally advanced rectal cancer (LARC): dosimetric comparison and clinical implications. Radiat Oncol. 2010;5:17

[26] Chinese Society of Radiation Oncology, Chinese Medical Association Radiation Oncology Branch, Chinese Anti-Cancer Association Radiation Oncology Professional Committee. Chinese guidelines for radiotherapy of prostate cancer (2020 version). Chines J Cancer Prev Treat. 2021;28(5):323–337.

[27] Chinese Society of Radiation Oncology, Chinese Medical Association Radiation Oncology Branch, Chinese Anti-Cancer Association Radiation Oncology Professional Committee. Chinese guidelines for radiotherapy of rectal cancer (2020 version). Int J Oncol. 2021;48(7):389-401.

[28] The Brachytherapy Group of China Society for Radiation Oncology, The Gynecological Oncology Group of Chinese Association for Therapeutic Radiation Oncologists, The Brachytherapy Special Committee of Chinese Anti-Cancer Association. Chinese expert consensus on three-dimensional image guided brachytherapy for cervical cancer. Radiat Oncol J. 2020;29(9):712–717

[29] VanniG, Pellicciaro M, MaterazzoM, et al. Advanced stages and increased need for adjuvant treatments in breast cancer patients: the effect of the one-year COVID-19 pandemic. Anticancer Res. 2021;41(5):2689–2696

[30] SmitSG, HeynsCF. Management of radiation cystitis. Nat Rev Urol. 2010;7(4):206–214

[31] GoswamiAK, Mahajan RK, NathR, et al. How safe is 1% alum irrigation in controlling intractable vesical bleeding?J Urol. 1993;149(2):264–267.

[32] ArrizabalagaM, Extramiana J, ParraJL, et al. Treatment of massive haematuria with aluminous salts. Brit J Urol. 1987;60(3):223–226.

[33] PhelpsKR, NaylorK, BrienTP, et al. Encephalopathy after bladder irrigation with alum: case report and literature review. Am J Med Sci. 1999;318(3):181–185.

[34] AlfreyAC. Aluminum toxicity in patients with chronic renal failure. Ther Drug Monit. 1993;15(6):593–597

[35] PascoeC, DuncanC, LambBW, et al. Current management of radiation cystitis: a review and practical guide to clinical management. BJU Int. 2019;123(4):585–594

[36] ZiegelmannMJ, Boorjian SA, JoyceDD, et al. Intravesical formalin for hemorrhagic cystitis: a contemporary cohort. Can Urol Assoc J. 2017,11(3-4):E79-E82.

[37] WuS, LanM. Local use of rhGM-CSF for the treatment of chemoradiotherapy induced oral mucositis. Drug Evaluation. 2012;9(30):4–7

[38] Vela-OjedaJ, Tripp-Villanueva F, Sanchez-CortesE, et al. Intravesical rhGM-CSF for the treatment of late onset hemorrhagic cystitis after bone marrow transplant. Bone Marrow Transplant. 1999;24(12):1307–1310.

[39] GargA, Dasgupta R, ShahS, et al. Role of intravesical granulocyte-macrophage colony-stimulating factor in controlling hemorrhagic cystitis in patients undergoing stem cell transplantation-A retrospective cohort study. Ind J Transplant. 2021;15(2):111

[40] NiuX, XuX, GuoZ, et al. Granulocyte-macrophage colony stimulating factor bladder irrigation prevents hemorrhagic cystitis after hematopoietic stem cell transplantation. J Clin Rehabil Tissue Eng Res. 2009;13(27):5229–5233.

[41] JiangYi, LiJ, ZhangJ, et al. Efficacy of compound Kushen liquid combined with Chinese herbal enema in the treatment of radiation cystitis and enterocolitis. Chin J Inf Tradit Chin Med. 2011;18(10):70–71

[42] ZhangX, WangW, LiM, et al. Clinical Study on Treatment of Radiogenic Cystitis after Radiotherapy of Cervical Cancer by Oral Administration of Xiaoji Yinzi Combined with Bladder Perfusion of Kangfuxin Liquid. Liaoning Journal of Traditional Chinese Medicine. 2021;48(11):96–99

[43] XiongN, HuZ, GuoH, et al. Experience of 16 cases of delayed-onset radiation cystitis treated with Chinese medicine. Journal Of Jiangxi College Of Traditional Chinese Medicine. 1999;11(3):103

[44] AlazemK, Cavallo JA, VanniAJ. Radiation cystitis: a contemporary review. Curr Bladder Dysfunct Rep. 2019;14(4):246–255

[45] VillerirsL, TaillyT, OstP, et al. Hyperbaric oxygen therapy for radiation cystitis after pelvic radiotherapy: systematic review of the recent literature. Int J Urol. 2020;27(2):98–107

[46] OscarssonN, MullerB, RosenA, et al. Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial. Lancet Oncol. 2019;20(11):1602–1614.

[47] FeldmeierJJ. Hyperbaric oxygen for radiation cystitis. Lancet Oncol. 2019;20(11):1481–1482.

[48] PiazzaP, Rosiello G, ChaconVT, et al. Robot-assisted cystectomy with intracorporeal urinary diversion after pelvic irradiation for prostate cancer: technique and results from a single high-volume center. Europ Urol. 2021;80(4):489–496.

[49] ManganoMS, De Gobbi A, CiacciaM, et al. Actinic cystitis: causes, treatment and experience of a single centre in the last five years. Urologia. 2018;85(1):25–28.

[50] Rodriguez-PatronRodriguez R, Sanz MayayoE, GomezGarcia I, et al. Hypogastric artery embolization as a palliative treatment for bleeding secondary to intractable bladder or prostate disease. Arch Esp Urol. 2003;56(2):111–118.

[51] FaziliT, BhatTR, MasoodS, et al. Fate of the leftover bladder after supravesical urinary diversion for benign disease. J Urol. 2006;176(2):620–621.

RIGHTS & PERMISSIONS

2024 The Authors. Precision Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Shandong Cancer Hospital & Institute.