Pelvic complications after interstitial and external beam irradiation of urologic and gynecologic malignancy

Schellhammer, Paul F.; Jordan, Gerald H.; El‐Mahdi, Anas M.

doi:10.1007/bf01658142

Cited by 38 publications

(14 citation statements)

References 47 publications

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“…A further clinical complication is that radiotherapy often induces more serious damage, including loss of bladder tissues, bladder shrinkage with fibrosis, and synechia between urinary bladders and intestines. 1,12,17,19,20 For these severe cases, treatment would require a combination of scaffolds, such as a bio-matrix and/or growth factors that support the implanted cells. The present study, at least, showed that the implantation of bone marrow-derived cells has the potential to recover the radiotherapy-induced bladder dysfunctions before more severe damage occurs.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, patients receiving pelvic radiotherapy complain about rectal disturbance, erectile dysfunction, [1][2][3][4] and/or urinary dysfunction, [5][6][7][8][9] which impair social interactions and reduce the quality of life. [10][11][12] Recently, the relationship between the spatial distribution of the external beam during radiotherapy and the consequential dysfunction of normal organs has been investigated to try and avoid the side effects. [13][14][15][16] The urinary bladder is one of the organs that is most often affected by the side effects of pelvic radiotherapy.…”

mentioning

confidence: 99%

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Bone Marrow-Derived Cells Implanted into Radiation-Injured Urinary Bladders Reconstruct Functional Bladder Tissues in Rats

Imamura

Ishizuka

Zhang

et al. 2012

Tissue Engineering Part A

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The purpose of this study was to determine whether bone marrow-derived cells implanted into radiation-injured urinary bladders could reconstruct functional bladder tissues. The pelvic region of anesthetized female SpragueDawley (SD) rats was irradiated with 2 Gy once a week for 5 weeks. After the last irradiation, the rats were maintained for 2 weeks. Bone marrow cells were harvested from the femurs of donor male green fluorescence protein (GFP)-transfected SD rats and cultured for 7 days. Two weeks after the last radiation exposure, the cultured adherent, proliferating bone marrow-derived cells were implanted into the walls of irradiated urinary bladders. For controls, cell-free solutions were similarly injected. Four weeks after donor cell or control implantations, cystometric, histological, and immunohistochemical investigations were performed. Two weeks after the last irradiation, the smooth muscle layers and nerve fibers of the irradiated urinary bladders were disorganized. The proportions of smooth muscle layer and nerve fiber areas were significantly decreased compared with sham-irradiated urinary bladders. In addition, the remaining smooth muscle cells within the irradiated urinary bladders expressed P4HB, an indicator of collagen synthesis. In the cystometric investigations, the voiding interval of irradiated rats was irregularly prolonged, 7.92 -1.09 min, and the residual volume, 0.13 -0.03 mL, was significantly higher compared with the sham-irradiated rats (5.50 -0.43 mL and 0.05 -0.01 mL). After 4 weeks, the smooth muscle layers and nerve fibers in the cell-free control urinary bladders remained similar to the preimplanted irradiated urinary bladders; however, the cell-implanted urinary bladders contained reconstructed smooth muscle layers and nerve fibers, the proportions of each were significantly higher than those in the cell-free injected controls. The expression of P4HB within the cell-implanted urinary bladders decreased. Some GFPpositive implanted cells differentiated into smooth muscle-and nerve-like cells and became organized into the reconstructed tissues. The voiding interval of the cell-implanted rats, 5.46 -0.33 min, was regular and similar to that of the sham-irradiated rats, and significantly less than that of the cell-free injected controls, 7.39 -0.54 min. The residual volume, 0.04 -0.01 mL, was similar to that of the sham-irradiated rats and significantly decreased compared with that of the cell-free injected controls, 0.15 -0.05 mL. Therefore, the implantation of bone marrowderived cells is a potentially useful treatment for radiotherapy-induced urinary dysfunctions.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Bone Marrow-Derived Cells Implanted into Radiation-Injured Urinary Bladders Reconstruct Functional Bladder Tissues in Rats

Imamura

Ishizuka

Zhang

et al. 2012

Tissue Engineering Part A

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“…18 -20 The most common factors have been radiation dose and multiple previous transurethral bladder resections. 20 The incidence rate of PRF after radiotherapy has been less well characterized, especially in the transperineal era. The incidence rate of PRF after BT varies from 0% to 7% (Table 4).…”

Section: Discussionmentioning

confidence: 99%

Prostatourethral-rectal fistula after prostate brachytherapy

Theodorescu

Gillenwater

Koutrouvelis

2000

Cancer

154

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“…However, the total allowable radiation dose is limited by the potential for developing irradiation-induced cystitis (35). Pathologically, irradiation damage to the bladder occurs in three distinct phases (36).…”

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confidence: 99%

Manganese superoxide dismutase gene therapy protects against irradiation-induced cystitis

Kanai¹,

Zeidel²,

Lavelle³

et al. 2002

American Journal of Physiology-Renal Physiology

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Urinary bladder cystitis occurs in patients receiving radiation therapy for pelvic tumors. Radiation-induced formation of superoxide radicals is believed to damage the urothelium, exposing the underlying bladder smooth muscle to urine, culminating in nerve irritation and muscle dysfunction. We tested whether overexpression of MnSOD could decrease superoxide levels and protect the bladder from radiation damage. Pelvic irradiation led to sloughing of urothelial umbrella cells, with decreased transepithelial resistance, increased water and urea permeabilities, and increased expression of inducible nitric oxide synthase. Six months after irradiation, cystometrograms showed elevated intravesical pressures and prolonged voiding patterns. However, urothelia transfected with the MnSOD transgene recovered from radiation injury more rapidly, and detrusor function was much closer to that of control bladders than irradiated bladders without the transgene. We conclude that MnSOD gene therapy is protective, which could lead to its use in mitigating radiation cystitis and preventing dysfunction of the urinary bladder.

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Pelvic complications after interstitial and external beam irradiation of urologic and gynecologic malignancy

Abstract: World maiof Sdr ry 9 1986 by the Soci~t6 Internationale de Chirurgie

Cited by 38 publications

References 47 publications

Bone Marrow-Derived Cells Implanted into Radiation-Injured Urinary Bladders Reconstruct Functional Bladder Tissues in Rats

Bone Marrow-Derived Cells Implanted into Radiation-Injured Urinary Bladders Reconstruct Functional Bladder Tissues in Rats

Prostatourethral-rectal fistula after prostate brachytherapy

Manganese superoxide dismutase gene therapy protects against irradiation-induced cystitis

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