Is Aktocyte 750 (autologous cellular therapy) effective for treating radiation-induced cystitis?

Aktocyte 750 for Radiation-Induced Cystitis

There is no evidence supporting the use of Aktocyte 750 (autologous cellular therapy) for treating radiation-induced cystitis in the provided literature.

Understanding Radiation-Induced Cystitis

• Radiation-induced cystitis results from damage to bladder vasculature and vascular endothelial cells, causing symptoms like dysuria, urinary frequency, nocturia, hesitancy, infection, discomfort, and hematuria 1
• Acute symptoms typically occur after a 20 Gy dose to the bladder and subside 2-3 weeks after treatment completion 2, 1
• Chronic symptoms can develop with a latency period of 1-25 years due to progressive vascular damage 1
• About 50% of women experience acute urinary symptoms after pelvic radiotherapy for gynecologic malignancies 2

Risk Factors

• History of abdominal surgery, pelvic inflammatory disease, hypertension, diabetes mellitus, and smoking increase risk of late genitourinary toxicity 2, 1
• Older age significantly impacts incontinence risk due to potentially higher bladder neck doses 1
• Obesity and overweight are risk factors for urinary incontinence and frequency 2, 1

Evidence-Based Management Options

First-Line Treatments

• Hydration, non-steroidal anti-inflammatory drugs, and anticholinergic agents for mild to moderate symptoms 2
• Botulinum toxin A injection into the detrusor muscle when drug therapy is ineffective 2, 1

For Hemorrhagic Cystitis

• Hyperbaric oxygen therapy, clot evacuation, endoscopic fulguration, and bladder irrigation 2, 1
• Hyperbaric oxygen therapy has shown short-term benefits but often fails to provide long-term cure, with success rates varying from 60% to 92% 3, 4
• In one long-term study, only 27% of patients experienced complete and durable resolution of symptoms with hyperbaric oxygen therapy 3

Refractory Cases

• Surgical interventions including percutaneous nephrostomy, ureteral stent placement, or ileal ureteral substitution 2, 1
• Cystectomy may be required in severe cases unresponsive to other treatments 4

Treatment Algorithm

1. Initial management:

   • Confirm diagnosis and rule out infection with urine analysis and culture 1
   • Start with hydration, NSAIDs, and anticholinergic agents 2, 1

2. If symptoms persist:

   • Consider botulinum toxin A injection into the detrusor muscle 2, 1

3. For hemorrhagic cystitis:

   • Implement bladder irrigation and clot evacuation 1
   • Consider endoscopic fulguration of bleeding points 4
   • Evaluate for hyperbaric oxygen therapy if available 3, 4

4. For refractory cases:

   • Consider surgical interventions including urinary diversion 2, 1

Important Considerations

• Infection and primary bladder malignancy must be ruled out in patients with persistent symptoms 1
• Poor vascularity and wound healing following radiation can make surgical interventions challenging 1
• Management of radiation-induced cystitis often requires a multimodal approach as no single treatment has shown consistent long-term efficacy 5
• Bladder biopsies should be avoided unless findings suggest a bladder tumor, as they may precipitate complications 6

Prevention Strategies

• Different IMRT modalities may reduce the rate of acute and late high-grade urinary toxicity 2, 1
• To reduce severe urinary complications, a D2cm³ ≤ 80 Gy EQD2 should be used 2
• Dose to the bladder trigone should be minimized as it is predictive of severe late urinary toxicity 1