Follow-up/Toxicity Flashcards
What are the toxicities associated with RT for organ preservation?
Short-term complications: transient urinary frequency/urgency, dysuria, hematuria, bladder spasms, diarrhea, RT dermatitis, fatigue
Relatively common long-term complications: chronic urinary frequency/urgency, erectile dysfunction, diarrhea
Uncommon long-term complications: chronic hematuria (especially in pts on blood thinners), dysuria, urgency, bowel obstructions or fistulas, pelvic insufficiency fractures, 2nd cancers
What is the impact of bladder preservation approaches on QOL for pts with bladder cancer?
QOL for pts after bladder preservation therapy is good. Urodynamic studies and pt-reported outcome studies found that 78% of pts retained normal bladder function; bowel Sx were reported by 22% and 50% reported normal erectile function (Zietman ZS et al., J Urol 2003). A recent QOL study compared MIBC pts receiving cystectomy vs. organ preservation trimodality therapy. At 5.6-yr median follow-up, multivariate analysis showed that the organ preservation group a better general QOL as well as better bowel function, fewer bowel Sx, and better sexual function compared to the cystectomy group; urinary Sx scores were similar. (Mak KS et al., IJROBP 2016)
How many pts require cystectomy for palliation of Tx-related toxicities following bladder preservation?
Cystectomies performed for palliation of bladder preservation–related toxicities are very uncommon (0%–2%). (Rodel C et al., JCO 2002; Shipley WU et al., J Urol 2002)
What is the recommended f/u for pts with MIBC treated with bladder preservation?
Urine cytology, cystoscopy + Bx, imaging of the upper urinary tracts, abdomen, pelvis q3–6 mos for the 1st 2 yrs, and then at increasing intervals. LFTs, BMP, and chest imaging performed q6–12 mos.
