Hyberbaric oxygen as sole treatment for severe radiation - induced haemorrhagic cystitis

Abstract

Purpose To examine the safety and efficacy of hyperbaric oxygen as the primary and sole treatment for severe radiation-induced haemorrhagic cystitis.Materials and methods Hyperbaric oxygen was prospectively applied as primary treatment in 38 patients with severe radiation cystitis. Our primary endpoint was the incidence of complete and partial response to treatment, while the 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 with a mean follow-up of 29.33 months. Median number of sessions needed was 33. Complete and partial response rate was 86.8% and 13.2%, respectively. All 33 patients with complete response received therapy within 6 months of the haematuria onset. One patient needed cystectomy, while 33 patients were alive at the end of follow-up.Conclusions Our study suggests the early primary use of hyperbaric oxygen for radiation-induced severe cystitis as an effective and safe treatment option.

Hyperbaric oxygen therapy for radiation cystitis after pelvic radiotherapy: Systematic review of the recent literature

“…It was reported that in the non‐recurrent cases, the latter interval was 0.7 years on average (SD 0.5 years, range 0.1–1.8 years), whereas it lasted 2.3 years (SD 1.2 years, range 0.2–4.8 years) in the recurrent cases . This was corroborated by Dellis et al ., who observed that all patients with a CR had their HBOT within a mean period of 4.9 months (range 1–6 months) after the onset of hematuria, whereas this interval was significantly longer (22 months, range 8–48 months, P < 0.001) in patients with a PR . Ferreira et al .…”

“…Summarizing all included studies, the overall response rate varied between 64.8% and 100.0% (86.4% weighted average across the studies) in studies that provided this overall response value . The CR rate varied between 20.0% and 100.0% (63.6% weighted average) .…”

“…Radiation doses ranged between 36 and 138 Gy to the pelvis. Of the 20 studies, 12 reported the interval between the final RT and the onset of symptoms, which ranged between 0 and 396 months . Transfusion was carried out in the case of major blood loss, but just 11 studies reported the exact number of patients in whom blood transfusion was required .…”

“…reported a total response to HBOT of 79.4% in transfused patients, whereas Dellis et al . reported PR or CR in all patients in a population with RTOG grade IV radiation cystitis who all required blood transfusions …”

Management of Hematuria All You Always Wanted to Know

“…In cases of acute actinic cystitis, TRUB coagulation of bleeding points is a common technique. However, in recurrent patients, treatment with hyperbaric oxygen is frequently used achieving a complete and partial response rate in 86.8% and 13.2% of cases respectively (Dellis et al, 2017). Other common treatment for this condition, is bladder instillation with sodium hyaluronate for at least 8 weeks (Martinez et al, 2015).…”