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A contemporary review about the management of radiation-induced hemorrhagic cystitis

Dautruche, Antoinea; Delouya, Guilaa,b

Current Opinion in Supportive and Palliative Care: September 2018 - Volume 12 - Issue 3 - p 344–350
doi: 10.1097/SPC.0000000000000375
RENAL AND UROLOGICAL PROBLEMS: Edited by Fred Saad

Purpose of review There are various specific therapeutic intervention available to treat hemorrhagic cystitis, once emergency treatment has been carried out. The lack of prospective studies, because of the relative rarity of this condition, makes it difficult to hierarchize the therapeutic sequence. The present review presents and summarizes the literature published on radiation-induced hemorrhagic cystitis from April 2015, date of a precedent exhaustive review, to March 2018.

Recent findings During our period of interest, 13 clinical studies and two new clinical trials protocols were published. Most of the clinical studies were retrospective and presented data about hyperbaric oxygen (HBO) therapy, comforting its place as a well tolerated and effective first-line treatment. Other studies reported the outcomes of treatments with alum, formalin, silver nitrate, fulguration with laser or definitive surgery.

Summary Although authors seem to agree that formalin and surgery have their role as effective but potentially morbid last-line treatments, there is no consensus on primary approach to management of radiation-induced hemorrhagic cystitis beyond symptomatic measures. Several treatments have proven excellent response rates and few side effects. The results of on-going prospective studies on mesenchymal stromal cells or tacrolimus instillations are awaited, but the main discriminating factor to choose between treatments remains local availability.

aDepartment of Radiation Oncology

bCRCHUM-Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Canada

Correspondence to Guila Delouya, Centre hospitalier de l’Université de Montréal (CHUM), 1055, rue Sanguinet, Radio-oncologie, Pavillon C, porte C.S3.5002, Montréal (Québec) H2X 3E4. Tel: +1 514 890 8254; fax: +1 514 412 7537; e-mail: guila.delouya.chum@ssss.gouv.qc.ca

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