Following IRB approval, twenty women signed consent and were prospectively enrolled over the 10 month study period (May 2019 to February 2020). There were a total of 40 unique patient encounters and 38 complete questionnaire sets which were completed (AUASS, ICIQ FLUTS, SF12). Mean age was 59.1 +/- 14.8 years (range 19-77). Cancer diagnoses included: 4 cervical cancer, 13 endometrial cancer, and 3 other pelvic malignancies (ovarian cancer, sarcoma). Radiotherapy treatments included 11 women who underwent brachytherapy, 3 EBRT, and 6 combination radiotherapy (brachytherapy + EBRT). Prior pelvic surgical treatments included 14 women treated with radical hysterectomy (with bilateral salpingo-oophorectomy and pelvic lymph node dissection). There were 2 women who were pre-menopausal, and the remaining 18 women were post-menopausal at time of radiotherapy. Women previously had a median number of 2 (range 0-8) pregnancies and 2 (range 0-5) deliveries. Mean BMI was 30.1 +/- 8.5 kg/m^2.
For the LUTS storage domains (daytime frequency, urinary urgency, nocturia), there were differences in the magnitude of change over time when contrasting the AUASS against the ICIQ-FLUTS (Figure 1). Daytime frequency (AUASS #2, FLUTS #5) was decreased by 1-2 AUASS points in approximately 50% of the women during brachytherapy, meanwhile FLUTS score increased in most patients over time (AUASS #2 vs. FLUTS #5 Spearman r=0.443, p=0.005). Similarly for the urgency domain (AUASS #4, FLUTS #3) AUA scores had dramatic 2 to 4 point changes in all directions, while FLUTS scores were more consistently changed across patient groups, and were worse in combined radiotherapy (AUASS #4 vs. FLUTS #3 Spearman r=0.700, p<0.001). For the nocturia domain (AUASS #7, FLUTS #2) there were high baseline AUA scores in the brachytherapy group, where some had paradoxical improvement and some worsened following radiotherapy, meanwhile the FLUTS scores appeared more consistent (AUASS #7 vs. FLUTS #2 Spearman r=0.832, p<0.001). Generally, women undergoing combination radiotherapy had worse or unchanged nocturia during treatment, and following radiotherapy there was consistently greater nocturia reflected in both the AUASS and FLUTS.
For the LUTS voiding domains (weak stream, urinary hesitancy, straining, intermittency), there were again differences in the magnitude of change over time when contrasting the AUASS against the ICIQ-FLUTS (Figure 2). Urinary hesitancy (FLUTS #6) was not a common problem during brachytherapy, however manifest more long-term after EBRT and combination radiotherapy, although this may reflect a referral pattern for these groups. Similarly, straining (AUASS #6, FLUTS #7) was not a common problem during brachytherapy, as reflected by FLUTS scores, but was more pronounced during and after EBRT and combination radiotherapy. Straining scores were closely correlated (AUASS #6 vs. FLUTS #7 Spearman r=0.753, p<0.001). Intermittency domain (AUASS #3, FLTUS #8) scores fluctuated over the acute time course, with brachytherapy group having fairly high AUA baseline scores which seemed to improve during/after radiotherapy, meanwhile FLUTS scores did not show this trend through the course of radiotherapy. Women undergoing combination radiotherapy had higher AUA scores, but only a mild increase in FLUTS scores during radiotherapy, meanwhile at long term follow-up after EBRT there were consistently higher scores in both the AUASS and FLUTS. Intermittency scores were closely correlated (AUASS #3 vs. FLTUS #8 Spearman r=0.827, p<0.001).
For the LUTS incontinence domains, women had relatively high incontinence scores at baseline (FLUTS #9-12). There were paradoxical changes in incontinence score during/after brachytherapy, discordant with expected pathophysiology. Combination treatment was associated with increased or no change in incontinence during radiotherapy, meanwhile on long-term follow-up combination and EBRT women usually had high incontinence scores, although this may reflect a referral pattern. Bladder pain (FLUTS #4) was temporarily increased during brachytherapy and combination radiotherapy, whereas on long-term follow-up bladder pain was much greater in each of these groups. For the overall quality of life domains, perception of overall health (SF12), was reported as good or very good by most brachytherapy patients, with no clear trend during treatment and improvement after treatment has ended (Figure 2). Combination radiotherapy and EBRT patients had generally worse perception of overall health (SF12) and AUASS QOL, and overall for all groups scores between these domains were moderately correlated (AUASS QOL vs. SF12 Spearman r=0.450, p=0.005).