No high quality evidence for the application of any non-surgical treatment for late radiation cystitis
Citation: Denton AS, Clarke N, Maher J. Non-surgical interventions for late radiation cystitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD001773. DOI: 10.1002/14651858.CD001773.

Background: Chronic radiation cystitis occurs a minimum of three months after completion of pelvic radiotherapy and represents a range of clinical symptoms for which there is as yet no recommended standard management.
Objectives: The aim of this review was to identify the various non-surgical treatment options for the management of late chronic radiation cystitis and evaluate the evidence.

Search methods: Synonyms for radiation therapy and for the spectrum of radiation toxicity to the bladder in both text and MeSH terms were combined and applied to a range of databases - Cochrane Central Register of Controlled Trials (CENTRAL), Register 2001; MEDLINE 1966 to 2001; EMBASE 1980 to 2001; CANCERCD 1980 to 2001; Science Citation Index 1991 to 2001; CINAHL 1982 to 2001,and sources of grey literature. We also hand searched textbooks and contacted experts in the field. In the current update the search was updated to April 2007.
Selection criteria: Randomised controlled trials (RCTs), studies of interventions for the non-surgical management of all grades of late radiation cystitis.

Data collection and analysis: Out of 85 relevant studies, there was one RCT that met the inclusion criteria and a prospective series (phase II study), both of these used the same intervention. In addition, there were three prospective case series and two non-RCTs which assessed different interventions and were not comparable.

Main results: Sixty-five reports met the stated inclusion criteria. The majority were predominantly retrospective case series with the exception of one RCT which used an agent called WF 10 (Veerasaran 2004), there were also two unrandomised and unblinded studies with a control group for comparison of effect, (Micic 1988), (intravesical placental extract) and (Milani 1988), (flavoxate). There is also a phase II series using WF 10 therapy.

Authors' conclusions: Late radiation cystitis is a relatively uncommon treatment complication and there are obvious difficulties in identifying sufficient patients to participate in a RCT. The number of published reports is a reflection of the degree of medical interest that exists in providing therapeutic solutions for late radiation cystitis. However, in spite of the two studies of level IIA evidence and the solitary RCT it is difficult to draw any firm conclusions.

Comments:
  1. Ageing review – now 15 years old. Search updated 2007.
  2. HBOT was included. 19 studies, 18 case series and one prospective study of 40 patients. Minimum reported response rate of 60%
  3. No conclusions made concerning HBOT

Update: December 2020




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