Details

Autor(en) / Beteiligte

• Bove, Pierluigi
• Iacovelli, Valerio
• Cipriani, Chiara
• Tirindelli, Maria Cristina
• Flammia, Gerardo Paolo
• Cindolo, Luca
• Ferraro, Angelo Salvatore
• Bianchi, Daniele
• Ferro, Matteo
• Arcese, William
• Ingrosso, Gianluca
• Vespasiani, Giuseppe
• Agrò, Enrico Finazzi

Titel

ENDOSCOPIC INTRAVESICAL FIBRIN GLUE APPLICATION IN THE TREATMENT OF REFRACTORY HAEMORRHAGIC RADIATION CYSTITIS

Ist Teil von

• Anticancer research, 2018, Vol.38 (4), p.2500

Ort / Verlag

Athens: International Institute of Anticancer Research

Erscheinungsjahr

2018

Quelle

Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals

Beschreibungen/Notizen

• Background/Aim: Hemorrhagic radiation cystitis (HRC) is a complication of radiation therapy to pelvic tumors for which, several treatment options are described (1, 2). However, a multitude of these are anecdotal and presented in case reports or very small case series and the paucity of high quality evidence in the form of randomized control trials does not allow to develop a standard of treatment. We have previously demonstrated the effectiveness of the endoscopic intravesical fibrin glue (FG) application for treating hemorrhagic cystitis after allogeneic stem-cell transplantation (3). Herein, on the base of our experience, we have evaluated the use of endoscopic intravesical FG application in a single cohort of refractory HRC patients. Patients and Methods: The data from 20 HRC patients treated with fibrin glue at our institution between May 2012 and May 2015 were reviewed retrospectively. All patients with grade ≥2 HRC (macroscopic hematuria), received endoscopic intravesical FG application after failure of conventional therapy. FG was obtained from virus-inactivated fresh frozen human plasma (Octaplas, Vienna, Austria) and produced using Vivostat System (Vivolution, Alleroed, Denmark), an automatic method for processing and applying FG starting from either whole blood or fresh frozen plasma. For each application, 12 ml of FG were prepared. Patient demographics, types of pelvic malignancy and radiotherapy, total radiation dose, onset and severity of hematuria, and prior intravesical management were evaluated. Clinical improvement was defined as (1) clinical response, disappearance of dysuria, urgency, and frequency; analgesic agent discontinuation; and Foley catheter removal with persistence of hematuria grade <2; (2) complete response, clinical response and absence of hematuria; or (3) no response, no clinical response and persistence of hematuria. Results: Twenty patients (8 females and 12 males, median age 69±7.50 years) received an endoscopic application of 12 ml of FG intravesically. HRC was due to prior pelvic radiation therapy for prostate cancer (n=7, 35%), bladder cancer (n=6, 30%), and gynecological malignancies (n=7, 35%). The median radiation dose was 60±2.50 Gy. The median time from radiation therapy to HRC onset was 3±1.90 years. The median duration of hematuria was 3.5±2.50 months. All patients had failed conventional therapy with hyperhydration, catheterization, continuous bladder irrigation and transurethral endoscopic clot evacuation and hemostasis. Four patients (20%) underwent multiple transfusions. Two patients were previously treated with an unsuccessful hypogastric artery embolization and transurethral endoscopic clot evacuation and hemostasis. Of the 20 patients, a complete response was obtained in 16 patients (80%) and a clinical response in 4 patients (20%). Four patients were treated twice. For the entire cohort, the median follow-up was 26.2±9.78 months. Treatment was well tolerated in all the patients. No major adverse events were reported. Minor adverse events included bladder spasms in 6 patients. No urinary tract infections were reported. Discussion and Conclusion: The results of this pilot study suggest that the endoscopic application of FG should be considered a safe and simple therapeutic tool for the management of refractory HRC developing in frail patients. In particular, FG therapy is a feasible, effective, repeatable, and affordable procedure for treating grade ≥2 HRC and should be applied early from the onset of HRC.