Journal of Clinical Oncology, Vol 6, 76-82, Copyright © 1988 by American Society of Clinical Oncology
Cyclophosphamide-induced hemorrhagic cystitis in Ewing's sarcoma
TJ Stillwell, RC Benson Jr and EO Burgert Jr
Department of Urology, Mayo Clinic, Rochester, MN.
Recent improvements in survival of patients with Ewing's sarcoma have been
made since the addition of cyclophosphamide-based adjuvant chemotherapy to
primary surgery and radiation. A potential limitation to cyclophosphamide
use is its urotoxicity, primarily in the form of hemorrhagic cystitis. The
incidence of this adverse effect in patients treated for Ewing's sarcoma
has not been established. In a Mayo Clinic series of 116 patients with
Ewing's sarcoma treated with cyclophosphamide, 17 (15%) developed
hemorrhagic cystitis diagnosed on the basis of gross hematuria or
cystoscopic findings (or both). Microscopic hematuria also occurred in 53%
of patients (56 of 105 examined). The dose and duration of therapy appeared
to be unrelated to the development of urotoxicity. Most patients recovered
uneventfully with or without discontinuation of cyclophosphamide therapy,
but a significant loss of blood occurred in three patients, and one patient
required a cystectomy because of bladder fibrosis. Long-term follow-up is
mandatory in these patients because of late recurrences of hemorrhagic
cystitis or the possibility of bladder carcinoma. New therapies, directed
at protecting the bladder from urotoxicity during cyclophosphamide
treatment, are available.
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