Complication grade of urinary function following radiation therapy treating pelvic malignancy

Abstract

Introduction: Pelvic malignancy (cervical, rectal and endometrial carcinoma) are a very common and deadly disease. Adjuvant therapy consists of regimens that include both concurrent chemotherapy/radiotherapy (RT) and adjuvant chemotherapy. The aim of the study was to evaluate and analyze renal function through the changes in GFR (Glomerular Filtration Rate), using 3D conformal radiotherapy (3DCRT) techniques in the treatment of patients with pelvic malignancy, and to evaluate acute and late toxicity of GU genito-urinary tract, during and after treatment according RTOG (Radiotherapy Oncology Group) scoring system. Analyzing patients adverse GU effects at the 9 and 12th month of treatment have been also helped by using cystoscopy. Methods: This study was conducted at the Clinical Center of Kosovo, Oncology Department. Several variables were evaluated in 75 patients: sex, age, type of primary malignancy, median tumor dose (TD) evidence over 50 and under 50 Gray (Gy). Time of the appearance of toxicity was followed by GFR changes during 3- and 6-month follow-up period. At the beginning, at 3rd and 6th months of the treatment patient have been followed by fulfilling in the questioner according RTOG scoring system. Chemotherapy have been employed based on primary tumor site concurrently with radiotherapy. Median follow up (FU) have taken 12 months. To the patient that had G2 and G3 adverse genito-urinary effects regarding RTOG at month 9 up to 12, was performed cystoscopy. Patients with pretreatment genitourinary morbidity (PGUM) were excluded from the study and patients who had genito-urinary problems such as obstruction in the beginning of treatment with the urinary tract ultrasonography examination have been excluded. Results: Our cohort consisted of 75 patients with pelvic malignancy, of whom 53 (70.7%) were female and 22 (29.3%) male. The average age of the patients included in the study was 57.5± 11.2 years. Thirty (40.0%) of the 75 patients had rectal carcinoma, 28 (37.3%) cervical cancer and 17 (22.7%) endometrial carcinoma. The average value of GFR in the beginning was 71.7± 23.1ml/min, it was 75.6 ± 25.6ml/min three months after beginning of therapy and 79.1±25.9 ml/min six months after therapy. The test of comparison showed a significant statistical difference between the values of GFR at the baseline of treatment vs three months after therapy (P<0.05), baseline of therapy vs six months after therapy (P <0.001), while there was no difference between GFR values three months and six months after therapy. In the follow up after 3 months, 11 patients (14.7 %) had G1 GU toxicity that did not need any kind of treatment. 5 patients (6.7%) had G2 GU toxicity. Whereas in the follow up after 6 months 15 patients (20%) had G1 GU toxicity, 7 patients (9.3%) G2 GU toxicity and 4 patients (5.3%) had G3 GU toxicity. Compering grade of toxicity between follow up 3 and 6 months no significant differences have been appeared according RT treatment. At the 9-12 months follow up we reached incidence of grade 1 and grade 2 urinary AEs (adverse effects) is 26.66%. Conclusion: Overall, the kidney function improved at 3 and 6 months in majority of patients. No significant differences in treatment related site effects between radiotherapy and chemo-radiation groups were found. Grade 3 AEs mostly have been appeared according to locally advanced cancer and progression after treatment. Patients that have performed cystoscopy have had slight or occasional damage to the walls of the bladder and they have not need any treatment. Same patients had like cystitis feeling symptoms with often wanting urination, straining to pass urine and burning urination.