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Published on: August 14, 2019
Effect of Pelvic External Beam Radiation Therapy on Lower Urinary Tract Function of Pediatric Patients
Michael H Edwards1, Andrew Nicklawksi2, Gemma Beltran3
1Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colorado, USA.
Insights
Pediatric cancer survivors who received pelvic radiation therapy showed abnormal lower urinary tract function, particularly with plateau-shaped uroflow patterns and elevated post-void residuals. The Dysfunctional Voiding Scoring system was not a useful screening tool in this population.
Area of Science:
- Pediatric Oncology
- Urology
- Radiation Oncology
Background:
- Long-term effects of multimodal treatment on lower urinary tract (LUT) function in pediatric cancer survivors are not well-described.
- External beam radiation therapy (EBRT) is a common treatment for pediatric solid tumors, often involving the pelvic region.
- Understanding the impact of pelvic EBRT on LUT function is crucial for survivorship care.
Purpose of the Study:
- To investigate the effect of pelvic external beam radiation therapy (EBRT) on lower urinary tract (LUT) function in childhood cancer survivors (CCS).
- To compare patient-reported outcomes, non-invasive urodynamic studies, and post-void residuals (PVRs) between CCS who received pelvic EBRT and those who did not.
Main Methods:
- Prospective cohort study of CCS greater than 1 year off-therapy for a pediatric solid tumor.
- Subjects divided into cohorts based on pelvic EBRT exposure.
- Assessment included the Dysfunctional Voiding Scoring system (DVSS) survey, uroflow testing, and post-void residual (PVR) bladder scans.
Main Results:
- The pelvic radiation cohort showed a higher likelihood of abnormal uroflow patterns (81% vs. 56%) and abnormal PVR (OR 9.0, p = 0.002).
- The distribution of uroflow patterns differed significantly between groups (p = 0.03), with the radiation cohort more likely to exhibit a "plateau"-shaped curve (44% vs. 6%).
- Exploratory analyses suggested potential associations between pelvic EBRT dose and LUT dysfunction.
Conclusions:
- External beam radiation therapy (EBRT) appears to negatively impact lower urinary tract (LUT) function in childhood cancer survivors (CCS) treated with pelvic radiation.
- The Dysfunctional Voiding Scoring system (DVSS) may not be a sensitive screening tool for LUT dysfunction in this population.
- Further research is needed to elucidate the full impact of EBRT on LUT function and to develop improved screening methods.
Background:
Pediatric patients with pelvic solid tumors often receive multimodal treatment, but the long-term effects of this treatment on lower urinary tract (LUT) function are not well-described. This prospective cohort study (NCT05818462) investigates the effect of external beam radiation therapy (EBRT) on LUT function by comparing patient-reported outcome measures, non-invasive urodynamic studies, and post-void residuals (PVRs) amongst childhood cancer survivors (CCS).
Methods:
All subjects were CCS greater than 1 year off-therapy for a pediatric solid tumor. Subjects were divided into cohorts by whether they had received pelvic EBRT. Research subjects completed the Dysfunctional Voiding Scoring system (DVSS) survey, uroflow testing, and PVR bladder scan.
Results:
Thirty-two patients enrolled; half received pelvic EBRT (mean 30.0 Gy). There was an equal number of patients exposed to alkylators (69%) in each cohort. Radiation cohort was further off therapy (5.3 vs. 4.0 years). The pelvic radiation cohort was more likely to have abnormal uroflow patterns (81% vs. 56%, p = 0.12). The flow pattern distribution differed between groups (p = 0.03); the pelvic radiation cohort was more likely to have a "plateau"-shaped curve (44% vs. 6%) and abnormal PVR (odds ratio [OR] 9.0, p = 0.002). Exploratory conditional likelihood ratio models yielded potential associations between pelvic EBRT and LUTD, as well as a potential dose-response. There was no difference in DVSS scores between cohorts.
Conclusion:
EBRT appears to affect LUT function in CCS who received pelvic EBRT. DVSS does not appear useful as a screening tool in this population. Further study is needed to better appreciate the impact of EBRT on LUT function and develop more accurate screening tools.
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