Radiation cystitis MANAGEMNT

1. Dr. Kanhu Charan Patro
M.D,D.N.B[RT],P.D.C.R,C.E.P.C
[EX – TATA MEMORIAL HOSPITAL]
Consultant- Radiation Oncology
MAHATMA GANDHI CANCER HOSPITAL
VISAKHAPATNAM
Email-drkcpatro@gmail.com ,M-09160470564
Radiation cystitis

2.  Inflammatory
changes in the
urinary bladder
caused by ionizing
radiation. Also
called
RADIOCYSTITIS

3. • Radiation cystitis is a
complication of
radiation therapy to
pelvic tumors. The
urinary bladder can
be irradiated
intentionally for the
treatment of bladder
cancer or incidentally
for the treatment of
other pelvic
malignancies

5. • Tumors of the pelvic organs (ie, prostate,
bladder, colon, rectum) are common in men,
constituting 35% of expected new cancer
diagnoses for 2009.
• In women, cancer of the uterus, ovary, bladder,
rectum, and vagina/vulva were expected to make
up 14% of new cancer diagnoses in 2009.
• Radiation therapy is an important management
tool for the treatment of these malignancies,
creating significant potential for the development
of radiation injury to the bladder.

9. • Volume and area of bladder affected - If
affected, the trigone is more symptomatic
than is the dome of the bladder
• Dose rate (< 0.8Gy/h decreases risk of
cystitis) and daily fraction size (doses
>2Gy/fraction increase risk)
• Total dose - Toxicity increases when the total
dose received exceeds 60Gy to the bladder;
• Concurrent chemo

10. ORGAN
TISSUE
0 Grade 1 Grade 2 Grade 3 Grade 4 5
BLADDE
R
None
Slight
epithelial
atrophy
Minor
telangiectasia
(microscopic
hematuria)
Moderate
frequency
Generalized
telangiectas
ia
Intermittent
macroscopi
c hematuria
Severe
frequency and
dysuria
Severe
generalized
telangiectasia
(often with
petechiae)
Frequent
hematuria
Reduction in
bladder
capacity (<150
cc)
Necrosis
/
Contract
ed
bladder
(capacity
<100
cc)
Severe
hemorrh
agic
cystitis
death

31.  Detrusor instability
(40-50% of
patients)
 Decreased peak
flow rate
 Decreased bladder
compliance
 Decreased bladder
volume
(approximately 20%
volume reduction)

35.  Pentosan polysulfate
sodium is a low
molecular weight
heparin-like compound.
 It has anticoagulant and
fibrinolytic effects. The
mechanism of action of
pentosan polysulfate
sodium in interstitial
cystitis is not known.
 Pentosan is indicated for
the relief of bladder pain
or discomfort associated
with interstitial cystitis

36.  Pentoxifylline and
its metabolites
improve the flow
properties of blood
by decreasing its
viscosity. This
increases blood
flow to the affected
microcirculation
and enhances
tissue oxygenation

38.  Relaxing the
bladder by
inhibiting the
muscuranic effect
of acetylcholine
 Urgency, frequency
 5mg TDS

39. • local therapy consists of 5%
formalin pledgets placed
endoscopically on bleeding
points for 15 minutes and then
removed.
• For bladder irrigation, a 1-10%
solution (4% preferred) is used;
manually fill the bladder to
capacity under gravity
(catheter < 15cm above the
symphysis pubis); contact time
ranges from 14 minutes for a
10% solution to 23 minutes for
a 5% solution.
• This is a painful procedure and
requires a general anesthetic.
The response rate is 52-89%,
and the recurrence rate is 20-
25%.

40. • Aminocaproic acid is an
antifibrinolytic agent that
inhibits plasminogen
activation, thus decreasing
plasmin.
• Adult dosing is 200mg of
aminocaproic acid in 1L of
isotonic sodium chloride
solution. It is run
intravesically according to
the severity of bleeding and
continued for 24 hours
after bleeding stops.
• Aminocaproic acid has a
response rate of 91%, and
recurrences have not been
reported

41.  causes protein
precipitation in the
interstitial spaces
and cell
membranes,
causing contraction
of the extracellular
matrix and
tamponade of
bleeding vessels

42. • The mechanism of action of
conjugated estrogens in
radiation cystitis is unknown.
In patients with renal failure,
estrogen has been reported to
correct prolonged bleeding
time.
• However, in radiation cystitis
complications, bleeding time is
usually normal. Adult dosing is
5mg/day orally for 4-7 days.
• Conjugated estrogens have a
response rate of 100%, and the
recurrence rate is 20% (1
report of 5 patients only).

43.  Phenazopyridine is
an azo dye that has
local anesthetic or
analgesic action. It
acts directly on
urinary tract
mucosa when
excreted.

45. • HBO therapy has a
reported response rate
of 27-92%, and the
recurrence rate is 8-
63%.
• In adults, HBO is
administered as 100%
oxygen at 2-2.5atm.
Each session lasts from
90-120 minutes.
• patients receive HBO
sessions 5 days weekly
for a total of 40-60
sessions

47. • Ongoing gross hematuria
that does not respond to
bladder irrigations or
that requires numerous
transfusions
• Small, contracted bladder
with incontinence or
severe frequency
• Specific complications of
radiation (eg, fistulas,
hydronephrosis,
strictures)

57.  SCAVANGES FREE
RADICALS