Urinary adverse effects of pelvic radiotherapy

Area of Science:

• Oncology
• Radiation Oncology
• Urology

Background:

• Radiotherapy (RT) is a cornerstone in treating pelvic cancers, including those of the bladder, prostate, rectum, uterus, and cervix.
• While RT offers significant benefits for cancer control, it can lead to adverse effects (AEs) in the urinary tract.
• Acute urinary AEs are well-documented, but long-term or late-onset AEs remain less characterized.

Purpose of the Study:

• To review and highlight the characterization of late urinary adverse effects following pelvic radiotherapy.
• To emphasize the importance of recognizing and communicating these potential long-term complications to patients.

Main Methods:

• Review of existing literature on urinary adverse effects in patients undergoing pelvic radiotherapy for various cancers.
• Analysis of reported incidence rates and types of late urinary AEs across different cancer types and RT modalities (e.g., external beam radiation therapy, brachytherapy).

Main Results:

• Urinary AEs can manifest years after pelvic radiotherapy, with varying incidence depending on cancer type and treatment.
• For prostate cancer, 3-year cumulative risk for grade ≥2 urinary AEs is 28-30%. Brachytherapy shows varying AE rates (e.g., 6.2% grade 3 at 5 years).
• Bladder cancer patients experience 7-12% grade ≥3 urinary AEs at 5 years. Cervical cancer has a persistent risk of severe AEs, and endometrial cancer patients report worse urinary quality of life long-term.

Conclusions:

• Late urinary adverse effects following pelvic radiotherapy are a significant concern, often under-described in current literature.
• There is a need for greater awareness among healthcare providers regarding the potential for delayed urinary complications.
• Informed patient consent must include comprehensive discussion of these long-term risks to facilitate shared decision-making in cancer treatment planning.