Is there a role for hyberbaric oxygen as primary treatment for grade IV radiation-induced haemorrhagic cystitis? a prospective pilot-feasibility study and review of literature

Abstract

ARTICLE INFO ______________________________________________________________ ______________________Purpose: To examine the safety and efficacy of hyperbaric oxygen as the primary treatment for Grade IV radiation-induced haemorrhagic cystitis. Materials and Methods:Hyperbaric oxygen was prospectively applied as a primary treatment option in 11 patients with Grade IV radiation cystitis. Primary endpoint was the incidence of complete and partial response to treatment. Secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival.Results: All patients completed therapy without complications for a mean follow-up of 17.82 months (range 3 to 34). Mean number of sessions needed was 32.8 (range 27 to 44). Complete and partial response rate was 81.8% and 18.2%, respectively. However, in three patients the first treatment session was not either sufficient or durable giving a 72.7% rate of durable effect. Interestingly, all 9 patients with complete response received therapy within 6 months of the haematuria onset compared to the two patients with partial response who received therapy at 8 and 10 months from the haematuria onset, respectively (p = 0.018). The need for blood transfusion (p = 0.491) and the total radiation dose (p = 0.259) were not correlated to success-rate. One patient needed cystectomy, while all patients were alive at the end of follow-up. Conclusions: Early primary use of hyperbaric oxygen to treat radiation-induced grade IV cystitis is an effective and safe treatment option.

The use of hyperbaric oxygen therapy in the treatment of hemorrhagic cystitis after allogeneic stem cell transplantation from an unrelated donor

“…In these patients, HBO significantly reduced the further development of late irradiation injury. A similar conclusion was presented by Dellis et al [15], who proved that HBO therapy could be used not only as a treatment but also as a prevention in patients during and after pelvic radiation therapy. The authors concluded that HBO was safe both for the bladder structure and for patients.…”

“…Intravenous infusion of MSC caused in some patients disappearance of symptoms with no adverse effects but further studies are needed to confirm their efficiency [14]. HBO was introduced to improve the clinical state after radiation of various organs, including the bladder [5,[15][16][17]. Sufficient HBO therapy was described in both adult and pediatric patients [18,19].…”

Management of toxicities following pelvic irradiation for gynaecological cancers

“…HBO increases the bladder tissue oxygen tension, enhancing neovascularization and normal tissue growth with 80-92% improvement at 1 year and durable responses in more than 70% [42,43]. It should be considered before severe changes are established with greater benefit seen with younger age, treatment within 6 months of onset and higher radiation dose.…”

Radiation Induced Cystitis and Proctitis - Prediction, Assessment and Management

“…Overall rate of recurrence was 0.12/year. In a recent prospective study to define primary role of hyperbaric oxygen in radiation cystitis, 11 patients were treated with HBO (Dellis et al, 2014). Nine patients (81.8 %) and 3 patients (18.2%) had complete and partial response respectively.…”