title: High incidence of severe urologic complications following radiotherapy for cervical cancer in Japanese women.
abstract: BACKGROUND
  Good results have been obtained with radiation therapy for cervical cancer, but many patients suffer radiation-induced complications of adjacent organs. Some authors have reported that about 10% of patients treated with radiotherapy experience radiation-induced complications. We have previously reported that the incidence of spontaneous rupture of the urinary bladder is high in Japan but extremely low in the United States and Europe. In this study, we examined whether incidence or type of radiation-induced complications differs between Japan and the United States and Europe.
  
  
  METHODS
  A retrospective study was performed to determine the incidence among Japanese women of severe complications requiring surgical intervention following radiotherapy for cervical cancer. A total of 271 patients were treated at Kobe City General Hospital using external-beam therapy from December 1981 to March 1989. In 232 external-beam therapy was combined with high-dose-rate intracavitary brachytherapy with a remotely controlled afterloading system (RALS). The incidence and type of radiation-induced complications of the urinary tract, rectum, and intestine were determined following exclusion of 74 patients with evidence of disease recurrence or progression.
  
  
  RESULTS
  A total of 16 patients (8.1%) had urologic complications that required surgical intervention following irradiation, while a total of 26 patients (13.2%) had complications of the rectum or intestine that required surgical intervention following irradiation. Urologic complications occurred significantly later than those of the rectum and intestine (6.4 and 2.2 years, respectively) (P < 0.0001). The overall incidence of severe complications was comparatively higher than reported in the United States and Europe. The incidence of spontaneous rupture of the urinary bladder was particularly high (2.0%) in Japan.
  
  
  CONCLUSIONS
  The incidence of severe complications following radiotherapy is comparatively higher in Japan than in the United States and Europe. In particular, spontaneous rupture of the urinary bladder is common in Japan. This might be due to the use of high-dose-rate brachytherapy. Since brachytherapy is currently being used for prostate cancer, urologists and radiologists must consider the possibility of a high incidence of such severe complications, especially when using high-dose-rate brachytherapy.
authors.affiliation: Department of Urology, Shiga Medical Center for Adults, Moriyama City, Moriyama, 5-4-30, Japan. PS5K-FJKW@asashi-net.or.jp
authors.forename: K
authors.initials: K
authors.lastname: Fujikawa
authors.forename: T
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Y
authors.initials: Y
authors.lastname: Ihara
authors.forename: Y
authors.initials: Y
authors.lastname: Matsui
authors.forename: H
authors.initials: H
authors.lastname: Takeuchi
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects; D003092:Colitis / Q000209:etiology / Q000601:surgery; D003556:Cystitis / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D007422:Intestines / Q000528:radiation effects; D011832:Radiation Injuries / Q000209:etiology* / Q000628:therapy; D011878:Radiotherapy / Q000009:adverse effects; D012007:Rectum / Q000528:radiation effects; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D014517:Ureteral Obstruction / Q000209:etiology / Q000628:therapy; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000628:therapy; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery; D014551:Urinary Tract / Q000528:radiation effects; D014570:Urologic Diseases / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*