Prevention by intravesical hyaluronic acid (Cystistat®) of acute
radiation-induced cystitis in radiotherapeutic management of
cervical cancer
E. González Patiño, N. Salvador Garrido, E. Castro Gómez, R. Miguens Duarte, A. Varela Pazos, E.
Canosa Santos, C. Porto Vázquez.
Radiation Oncology Department.
Complexo Hospitalario Universitario. Hospital Clínico. Santiago de Compostela. Spain.
One of the main objectives in the radiotherapeutic management of cervical cancer is to the treat in a period nonsuperior to 8 weeks, since there
is evidence that by every day that surpasses this period of time, there is a 1% of loss in the probability of both tumor response and tumoral
control. In this therapeutic strategy is fundamental to avoid and control the appearance of secondary toxicity to the treatment that causes these
interruptions. The incidence of acute radiation-induced cystitis (RIC) during treatment varies, in the literature, between 3-6.7%. Concomitant
use of chemotherapeutic agents may work synergistically to increase the risk of developing bladder injury from radiation. The treatment with
intravesical hyaluronic acid (IV-HA) (Cystistat®) has demonstrated its effectiveness in different forms from interstitial cystitis. We present our
initial experience in the use if IV-HA instillations in the prevention of RIC in patients diagnosed of cervical neoplasia and treated with a curative
chemo-radiotherapy protocol.
Treatment schedule
week of
treatment
-1
IV-HA
CERVICAL CANCER
Patients data
Patients
14
Median age
61,5 y. (39-74)
Pathology
•epidermoid carcinoma: 4.
• adenocarcinoma: 3.
IB (> 4 cm): 2 ; II B: 6 ; III A: 1 ; III B: 3
Stage (FIGO)
1
P
E
L
V
I
C
CDDP
External beam radiotherapy (EBRT): 45 – 50 Gy/5-5,5 w (1,8 Gy/fx)
Concomitant (weekly) chemotherapy: CISPLATINUM (CDDP): 40 mg/m2
IV-HA
CDDP
2
(the day of HDR-brachytherapy: no EBRT or chemotherapy are administred)
CDDP
3
5
HDR brachytherapy (HDR-BT): 5 x 5,5 Gy to (point A)
If posible, HDR starts at the four week.
IV-HA
4
R
A
D
I
O
T
H
E
R
A
P
Y
Intravesical hialuronic acid (IV-HA)
IV-HA
(Cystistat®)
IV-HA
 One instillation in the week -1.
 Weekly instilations during EBRT.
CDDP
IV-HA
HDR-BT
IV-HA
IV-HA
 One instillation on each brachytherapy insertion, during the
treatment aplication, in order to maintain the same vesical
volume (50 ml) used for the planning CT.
 A weekly instillation for the following four weeks to the
conclusion of treatment.
CDDP
HDR-BT
IV-HA
Evaluation of bladder toxicity (RTOG/EORTC scale)
(previously to each IV-HA instilation)
HDR-BT
GRADE
IV-HA
6
HDR-BT
IV-HA
7
Stage IIB cervical carcinoma
PATIENTS (#)
1
2
3
4
2 (*)
4(*)
--
--
(*) HDR-BT treatment was started
HDR-BT
IV-HA
 no patients developed grade III toxicity.
 no treatment was disrupted due bladder toxicity
8
IV-HA
(X 4 weeks)
 all patients were free of vesical toxicity after the 2nd
week of conclusion of treatment
Although these are preliminary results and prospective studies are necesary to confirm this effect, in this short serie of patients the use of IVHA instillations had a protective effect on the vesical mucosa in the prevention of RIC, allowing finalizing the treatment in the scheduled time. In
our opinion, treatment must be started from the begining of chemo-radiotherapy schedule treatment, since the radiation injury takes place
already fron initials days of treatment. The study in ongoing in order to have more complete data in the next future.