Urologic Complications Requiring Intervention Following High-dose Pelvic Radiation for Cervical Cancer

• Published in: Urology (Ridgewood, N.J.) N.J.), 2021-05, Vol.151, p.107-112
• Main Authors: Beller, Haerin L., Rapp, David E., Zillioux, Jacqueline, Abdalla, Basil, Duska, Linda R., Showalter, Timothy N., Krupski, Tracey L., Cisu, Theodore, Congleton, Johnson Yates, Schenkman, Noah S.
• Format: Article
• Language: English
• Subjects: Carcinoma - radiotherapy; Cystitis - etiology; Cystoscopy; Female; Humans; Middle Aged; Nephrostomy, Percutaneous; Radiation Injuries - complications; Radiotherapy Dosage; Retrospective Studies; Stents; Ureteral Obstruction - etiology; Uterine Cervical Neoplasms - radiotherapy
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2020.09.011

To identify the incidence of radiation-induced urologic complication requiring procedural intervention following high-dose radiotherapy for cervical carcinoma, and to identify predictors of complication occurrence. We performed a retrospective chart review of cervical cancer patients undergoing radiotherapy with primary focus on procedural complications (Clavien-Dindo ≥ III). Clinical data were collected including radiation dose, procedure performed, timing of complication, and need for additional procedures. Univariate and multivariate logistic regression modeling was performed to assess predictive value of demographic and clinical variables. A total of 126 patients with FIGO stage 1A2-4B cervical cancer were included in study analysis, with 18 patients experiencing procedural complication (14.3%). A total of 22 complications were identified, representing an average of 1.2 complications per patient with complication. The most common complications were ureteral stricture and radiation cystitis. The most common nononcologic procedures performed in the treatment of these complications were ureteral stenting, percutaneous nephrostomy tube placement, and cystoscopy. Notably, a total of 259 procedures were performed in the treatment of urologic complications, representing 14.4 procedures per patient and 24.6 procedures per patient with ureteral stricture. Logistic regression demonstrated active smoking at the time of diagnosis to be a predictor of procedural complication. Radiotherapy in the treatment of cervical cancer is associated with a high rate of urologic procedural complication. These complications often require numerous procedures and long-term management given their complexity. These findings suggest a need for awareness and plans for multidisciplinary management of urologic complications in this patient population.