HEMORRHAGIC CYSTITIS FOLLOWING RADIOTHERAPY FOR STAGE IB CANCER OF THE CERVIX
HEMORRHAGIC CYSTITIS FOLLOWING RADIOTHERAPY FOR STAGE IB CANCER OF THE CERVIX
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DOI：
10.1006/gyno.1994.1278
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发表时间：
1994-11-01
影响因子：
4.7
通讯作者：
GERSHENSON, DM
中科院分区：
文献类型：
--
作者：
LEVENBACK, C;EIFEL, PJ;GERSHENSON, DM
我们的目的是研究Ib期宫颈癌患者在盆腔放疗后发生出血性膀胱炎的发病率、严重程度、时间、临床治疗和结局。在德克萨斯大学M。D.安德森癌症中心1960年至1989年。大多数患者接受了外部光束和腔内治疗的组合。出血性膀胱炎患者通过回顾性审查其病历进行识别，并对每次事件进行分级。共确定了116例（6.5%）出血性膀胱炎患者。初始发生率为1级（轻微发生），占59%，2级（反复轻微出血），占23%，3级（住院治疗），占18%。从开始放疗到出现血尿的中位时间为35.5个月（平均58个月）。至初始3级事件的中位时间为37.5个月（平均84个月）。精算生命表分析显示，血尿的风险在5年时为5.8%，10年时为7.4%，20年时为9.6%。5年、10年和20年时3级、4级（需要手术干预）或5级（死亡）并发症的风险分别为1.0%、1.4%和2.3%。大约三分之一的3级患者在首次发生3级事件后的中位3.5个月内再次住院治疗膀胱并发症，尽管其中一些再入院发生在多年后。相关的尿路感染是常见的。在任何情况下，膀胱镜膀胱活检显示复发性肿瘤或第二原发性肿瘤时，目视检查显示典型的辐射变化。Ib期宫颈癌放射治疗后严重出血性膀胱炎的发生率很低，可在治疗后多年发生。在尿培养结果出来之前，血尿的小发作可通过经验性抗生素治疗来控制。膀胱镜检查保留给持续出血的患者，以排除血块潴留或第二原发肿瘤或复发疾病的轻微可能性。如果有明显的放射性改变，应避免活检。凝块清除和持续膀胱冲洗仍然是严重出血患者的标准治疗。(C)学术出版社
Our purpose was to study the incidence, severity, timing, clinical management, and outcome for patients who developed hemorrhagic cystitis following pelvic radiotherapy for stage Ib cancer of the cervix. A total of 1784 patients with stage Ib cancer of the cervix were treated with pelvic radiotherapy at the University of Texas M. D. Anderson Cancer Center between 1960 and 1989. The majority received a combination of external-beam and intracavitary treatments. Patients with hemorrhagic cystitis were identified through retrospective review of their medical records, and a grade was assigned to each occurrence. A total of 116 (6.5%) patients with hemorrhagic cystitis were identified. The initial occurrence was grade 1 (minor occurrence) in 59%, grade 2 (repeated minor bleeding) in 23%, and grade 3 (hospitalization for medical management) in 18%. The median interval from the beginning of radiotherapy to the onset of hematuria was 35.5 months (mean 58 months). The median time to initial grade 3 occurrences was 37.5 months (mean 84 months). Actuarial life table analysis revealed that the risk of hematuria is 5.8% at 5 years, 7.4% at 10 years, and 9.6% at 20 years. The risk for a grade 3, 4 (requiring surgical intervention), or 5 (death) complication is 1.0, 1.4 and 2.3% at 5, 10, and 20 years, respectively. Approximately one-third of the patients with a grade 3 occurrence were rehospitalized for management of bladder complications a median of 3.5 months following the first grade 3 occurrence, although some of these readmissions occurred many years later. Associated urinary-tract infection was common. In no case did a cystoscopic bladder biopsy reveal recurrent tumor or a second primary tumor when visual inspection revealed typical radiation changes. The incidence of severe hemorrhagic cystitis following radiation for stage Ib cancer of the cervix is low and can occur many years following treatment. Minor episodes of hematuria are managed by empiric antibiotic therapy until the results of urine cultures are available. Cystoscopy is reserved for patients with persistent bleeding to rule out clot retention or the slight possibility of a second primary tumor or recurrent disease. Biopsy should be avoided if obvious radiation changes are present. Clot evacuation and continuous bladder irrigation remain the standard treatment for patients with heavy bleeding. (C) Academic Press, Inc.