Distressful symptoms after radical radiotherapy for urinary bladder cancer.
BACKGROUND
Radical radiotherapy for muscle-invasive urinary bladder cancer can sterilize the tumour with preserved organ function. Here we studied symptoms, symptom distress and trade-off among long-term survivors and compared figures to those of population controls and patients who had undergone cystectomy.


METHODS
We identified 71 patients who had had urinary bladder cancer treated with radical radiotherapy before 1995. For comparison, 325 patients treated with radical cystectomy and urostomy, continent or non-continent, during the same period and 460 individuals randomly selected from the general population were included. Information was collected by means of an anonymously answered postal questionnaire to avoid investigator-related bias.


RESULTS
Answers were obtained from 58 (82%) radiated patients, 251 (85%) cystectomized patients and 310 (71%) population controls. Of the radiated patients, 74% reported little or no distress from symptoms from the urinary tract, 38% had had intercourse the previous month and 57% (men) reported they had ejaculated. Among the cystectomized patients, 13% had had intercourse and 0% (men) had ejaculated. Moderate or much distress from symptoms from the gastrointestinal tract was reported by 32% of the radiated patients, 24% of the cystectomized patients and 9% of the population controls. After radical radiotherapy, 46% of the patients were willing to accept some risk of decreased survival to become symptom-free.


CONCLUSIONS
About 3/4 of these long-term survivors after radical radiotherapy for bladder cancer had a functioning urinary bladder with little or no distress from the urinary tract. The prevalence of sexual dysfunction was lower than after cystectomy and the prevalence of distress from the gastrointestinal tract was comparable.
Henningsohn
Lars
L
Clinical Cancer Epidemiology, Department of Oncology and Pathology, Radiumhemmet, Karolinska Institutet, Stockholm, Sweden.
Wijkström
Hans
H
Dickman
Paul W
PW
Bergmark
Karin
K
Steineck
Gunnar
G
D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology / Q000503:physiopathology; D008209:Lymphedema / Q000209:etiology; D008297:Male; D009361:Neoplasm Invasiveness; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects* / Q000523:psychology; D011897:Random Allocation; D020127:Recovery of Function / Q000528:radiation effects; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000503:physiopathology; D011795:Surveys and Questionnaires; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery