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Cyclophosphamide-induced hemorrhagic cystitis in Ewing's sarcoma
T J Stillwell1, R C Benson, E O Burgert
1Department of Urology, Mayo Clinic, Rochester, MN.
Summary
Cyclophosphamide chemotherapy improves Ewing sarcoma survival but can cause hemorrhagic cystitis. This study found 15% of patients developed this side effect, requiring monitoring for long-term bladder health.
Area of Science:
- Oncology
- Urology
- Clinical Medicine
Background:
- Cyclophosphamide-based chemotherapy improves survival for Ewing sarcoma.
- Cyclophosphamide's urotoxicity, specifically hemorrhagic cystitis, is a significant concern.
- The incidence of hemorrhagic cystitis in Ewing sarcoma patients is not well-established.
Purpose of the Study:
- To determine the incidence of hemorrhagic cystitis in patients with Ewing sarcoma treated with cyclophosphamide.
- To characterize the clinical presentation and outcomes of cyclophosphamide-induced urotoxicity.
- To highlight the need for long-term bladder surveillance in these patients.
Main Methods:
- Retrospective review of 116 Ewing sarcoma patients treated with cyclophosphamide at Mayo Clinic.
- Diagnosis of hemorrhagic cystitis based on gross hematuria or cystoscopic findings.
- Analysis of hematuria incidence and correlation with treatment parameters.
Main Results:
- 15% (17 of 116) of patients developed hemorrhagic cystitis.
- 53% (56 of 105) experienced microscopic hematuria.
- Urotoxicity was not dose or duration dependent; long-term complications included bladder fibrosis and potential carcinoma risk.
Conclusions:
- Hemorrhagic cystitis is a notable complication of cyclophosphamide therapy in Ewing sarcoma.
- Long-term follow-up is crucial due to potential late recurrences and bladder cancer risk.
- Protective strategies against cyclophosphamide-induced urotoxicity are warranted.