Incidence of Lower Urinary Tract Symptoms after Primary Chemoradiation for Cervical Cancer

Objectives: This study aims: (1) to quantify the frequency of LUTS among cervical cancer patients who underwent primary chemoRT and (2) to describe the utilization of non-surgical management options for LUTS in this patient population.

Methods: This retrospective study included patients with non-metastatic, primary cervical cancer who underwent primary chemoRT with curative intent and received their last dose between 06/01/2011 and 06/30/2019 at a large integrated healthcare system. Patients were followed until 6/30/2021 and were described by their frequency of LUTS, the time to the earliest LUTS, and frequency of treatments. Patients with a history of non-cervical gynecologic and urologic cancers, recurrent urinary tract infections, neobladder reconstruction, and/or patients who underwent a hysterectomy were excluded. Patients who were deceased within two years of treatment or prior to completion of chemoRT were also excluded.

Results: Ninety-five patients were included in our study. Forty-eight (50.5%) were white, 24 (25.3%) Asian or Pacific Islander, 18 (19.0%) Hispanic, and 4 (4.2%) Black. Mean age at last dose of chemoRT was 55.7 (SD 16.2) years. At time of diagnosis, the majority (75.8%) of cases were stage II or greater, and mean tumor size was 47.8 mm. The mean dose was 46.0 (SD 2.7) Gy for external beam radiation therapy and 23.4 (SD 3.2) Gy for brachytherapy. Of the 95 patients, 36 (37.9%) developed LUTS (Table 2). By first-diagnosed LUTS, 13 (36.1%) reported dysuria, 9 (25.0%) reported vaginal atrophy, 7 (19.4%) reported urinary incontinence, and 3 (8.3%) reported radiation cystitis. Average time to first LUTS diagnosis was 21.7 (SD 15.5) months and mean follow-up time was 64.0 (SD 28.6) months. Among patients with LUTS, 12 (33.3%) received some form of non-surgical treatment. Six (16.7%) received pelvic floor PT, 9 (25.0%) received pharmacologic treatment, and 3 (8.3%) received both. Cohort characteristics, LUTS diagnoses, and types of treatments are listed in Table 1.

Conclusions: In this large retrospective study of 95 patients with non-metastatic primary cervical cancer who underwent primary chemoRT with curative intent, 36 (37.9%) patients developed at least one LUTS following their last dose of chemoRT, with dysuria being the most common. One-third of those with LUTS received some form of non-surgical treatment. Our study suggests a potential need for both improved screening methods for LUTS in this patient population as well as more thorough counseling regarding non-surgical treatment options for these symptoms.