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![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](https://image.slidesharecdn.com/radiationcystitis-210209170322/75/Radiation-cystitis-MANAGEMNT-1-2048.jpg)
Uploaded byKanhu Charan
Radiation cystitis MANAGEMNT
This document discusses radiation cystitis, which is inflammation of the bladder caused by radiation therapy for pelvic cancers. It can cause symptoms like bleeding, urgency and frequency. The risks increase with higher radiation doses to the bladder and concurrent chemotherapy. Treatment options discussed include pentosan polysulfate, formalin, aminocaproic acid, conjugated estrogens, phenazopyridine and hyperbaric oxygen therapy. Surgical intervention may be needed for severe cases with complications or an unresponsive, contracted bladder.
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Radiation cystitis MANAGEMNT
- 1. Dr. Kanhu CharanPatro 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 protected] ,M-09160470564 Radiation cystitis
- 2. Inflammatory changes inthe urinary bladder caused by ionizing radiation. Also called RADIOCYSTITIS
- 3. • Radiation cystitisis 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 ofthe 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 andarea 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 1Grade 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 sodiumis 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 itsmetabolites 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 bladderby inhibiting the muscuranic effect of acetylcholine Urgency, frequency 5mg TDS
- 39. • local therapyconsists 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 acidis 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 precipitationin the interstitial spaces and cell membranes, causing contraction of the extracellular matrix and tamponade of bleeding vessels
- 42. • The mechanismof 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 anazo dye that has local anesthetic or analgesic action. It acts directly on urinary tract mucosa when excreted.
- 45. • HBO therapyhas 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 grosshematuria 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.