Table 4.
Summary of the key studies on intravesical therapy used in chemical- and RT-induced cystitis
| Author | Study design | Patients, n | Treatment | Efficacy | Adverse effects |
|---|---|---|---|---|---|
| Chondroitin sulphate | |||||
| Hazewinkel et al. (2011) [59] | Comparative pilot | Patients with gynaecological malignancies undergoing RT, 20 | Chondroitin sulphate vs no chondroitin sulphate | HC not reported. Trend towards less bothersome urogenital symptoms in treatment group | Well tolerated |
| Sodium hyaluronate | |||||
| Shao et al. (2012) [60] | Randomised | Patients with pelvic malignancies undergoing RT, 36 | Sodium hyaluronate vs HBO | Complete response:† | UTI: 42.8% vs 10.0% in first 6 months (P = 0.034) |
| 6 months: 87.5% vs 75.0% | |||||
| 12 months: 75.0% vs 50.0% | NS at 12 and 18 months | ||||
| 18 months: 50.0% vs 45.0% (all NS) | |||||
| Decrease in voiding frequency: significant at 6 months in both groups (P < 0.05) and at 12 months for sodium hyaluronate (P < 0.05) | |||||
| VAS: significant improvement maintained for 18 months in both groups. | |||||
| Sommariva et al. (2010) [61] | Prospective | Consecutive patients with cystitis receiving CT for bladder cancer or RT for prostate cancer, 69 | Sodium hyaluronate | After 4 weeks, bladder capacity increased in all patients, and urgency and pain disappeared. | No adverse effects observed |
| 97% reported complete relief of dysuria and pain | |||||
| Delgado et al. (2003) [62] | Retrospective | Consecutive patients with cervix/uterine cancer undergoing RT, 90 | Standard of care vs standard of care alone plus sodium hyaluronate | RT toxicity:* | Not reported |
| Week 4: 1.33 vs 0.71 (P < 0.005) | |||||
| End of RT: 1.24 vs 0.71 (P < 0.004) | |||||
| Samper Ots et al. (2009) [63] | Retrospective | Patients with acute vesical toxicity caused by BT, 95 | Sodium hyaluronate vs no sodium hyaluronate | Over whole study period, vesical toxicity significantly lower for sodium hyaluronate | No related adverse effects |
| (2.08% vs 12.8%; P < 0.05) | |||||
| Prostaglandin | |||||
| Ippoliti et al. (1995) [58] | Case series | BMT patients with grade III or IV HC, 24 | Prostaglandin F2α | 62% had total response with doses ≥0.8 mg/dL | 95.8% had bladder spasms |
| 9 (37.5%) patients relapsed at median of 7 days | |||||
| Levine et al. (1993) [64] | Case series | BMT patients, 16 and patients with cancer, 2 with HC after CYC treatment | Prostaglandin F2α | 50% had complete reduction in gross haematuria | 78.0% had bladder spasms |
| 3 cases of recurrent haematuria | |||||
| Formalin | |||||
| Lojanapiwat et al. (2002) [65] | Case series | Patients with pelvic malignancies and intractable haemorrhage secondary to RT-induced cystitis, 11 | 4% formalin | 82% had complete response | 4 major complications (e.g. anuria, fistula) and several minor (e.g. fever, tachycardia) complications |
| Dewan et al. (1993) [66] | Retrospective review | Patients with cervical cancer with HC after RT, 35 | 1% formalin | 89% had complete response and 8% partial response | Major complications in 11%, with 5 requiring subsequent urinary diversion. Probable formalin toxicity in 1 patient |
| Vicente et al. (1990) [67] | Retrospective review | Patients with HC after CYC or RT, 25 | 4% formalin | 88% had good result | 1 case of upper urinary tract dilatation |
| Alum irrigation | |||||
| Ho et al. (2009) [68] | Case report | Patient with ovarian cancer and HC after RT | 1% alum | Haematuria stopped after 24 h | Well tolerated |
CT, chemotherapy; CYC, cyclophosphamide; BT, brachytherapy; NS, not statistically significant;
*
Toxicity assessed using RTOG/EORTC Radiation Toxicity Score;
†
Complete response defined as the day when the symptoms improved.