Objective: To analyse the causes, clinical features, treatment and prevention of late bladder complications following radiotherapy of carcinoma of the uterine cervix.
Method: This clinical retrospective study included 378 cases of irradiation cystitis following radiotherapy for carcinoma of the uterine cervix from February, 1958 to October, 1987.
Results: The incidence of irradiation cystitis was 3.2% and was not related to age, FIGO staging and the methods of intracavitary irradiation (conventional or afterloading). It was related to the external appearance of the local lesion; 66.5% of the tumors of patients with late bladder complications was of the exophytic type prior to radiotherapy. 51.1% of the patients developed late bladder complications in a period of 2-5 years after radiotherapy; 16.7% in 5-10 years and only 3.4% within the first years. The patients with irradiation cystitis had received a 10% higher dosage than that routine delivered, as found either in intracavitary irradiation of 39.4% of patients or in external irradiation of 31.6% of patients. Based on the clinical features and cystoscopic findings, late bladder complications can be divided into three types: (1) sudden and temporary hematuria (35.7%); (2) persistent hematuria (63.2%); and (3) vesico-vaginal fistula (1.1%). The 5-year survival rate of patients with irradiation cystitis was 90.4% which was higher than the survival rates of all patients treated by conventional intracavitary irradiation (65.7%) and all patients treated by afterloading intracavitary irradiation (70.4%). 3.7% of patients died of late bladder complications.
Conclusions: To decrease the occurrence of late bladder complications and to obtain long term survival: (1) Dosage to the bladder should be adequate, and over dose to the bladder should by all means be avoided; (2) Patients are to be taught to observe indicated personal care during radiotherapy as well as in the follow-up period; (3) Early institution of proper conservative treatment of cystitis is beneficial.