Compliance with bladder protocol during concurrent chemoradiation for cancer of the cervix and its impact on enteritis: A prospective observational study

Aim

This prospective study aims to assess the compliance with bladder protocol and the correlation with enteritis during pelvic radiation.

Background

Bladder protocol is routinely used for patients undergoing pelvic radiation to reduce radiation enteritis. It is very difficult to maintain constant volume especially in the last two weeks due to radiation enteritis and cystitis.

Materials and methods

Histologically proven 35 cervical cancer patients treated with concurrent chemoradiation in a tertiary care center were the subjects of this prospective study. Following CT simulation and after every fraction, patients were asked to void urine in a calibrated urine container and the volume was documented. Patients were assessed for the highest grade of radiation enteritis weekly as per common toxicity criteria. The mean voided urine volume was correlated with the radiation enteritis.

Results

The mean urine volume at planning CT scan was 295.85 ± 300 ml (SD) with a range of 75–650. At the end of treatment, it was reduced to 233.14 ± 250 ml (range 50–400 ml), a reduction by 21% (p < 0.001). The maximum grade of enteritis was grade I (11%), II (11.4%), III (3–29%) in week 1,2 and 3–5, respectively with a p value of <0.001. A mean urine volume of 230 ml was associated with grade III enteritis in the third week.

Conclusions

Urine output volume measured using a calibrated container is a simple, efficient and practical method to monitor bladder distension thereby reducing enteritis in cervical cancer patients treated with concurrent chemoradiation.