Hyperbaric oxygen for long-term complications of radiation cystitis

Abstract

IntroductionBladder complications may be seen in up to 12% of patients treated with pelvic irradiation. To report the long-term efficacy of hyperbaric oxygen therapy (HBOT) on radiation-induced cystitis.MethodsWe followed 70 patients diagnosed with radiation cystitis submitted to HBOT in our institution from 2007 to 2013. All patients answered a questionnaire documenting symptom severity pre-HBOT and at the end of the follow-up period using the Late Effects of Normal Tissues – Subjective, Objective, Management, Analytical (LENT-SOMA) scale. Our treatment protocol consisted of multiple sessions (median of 40) of 100% oxygen delivery in a multiplace hyperbaric chamber at 2·4 atm for 80 minutes.ResultsWith a median follow-up of 55·5 (4–85) months, the success rate after the follow-up period in terms of haematuria resolution or improvement was 91·4%. The mean score of each subjective variable of LENT-SOMA scale (dysuria, frequency, haematuria, incontinence) were significantly lower after the follow-up period (p<0·05) with the exception of decreased stream (p=0·14). The sum of all subjective scores of LENT-SOMA scale was also significantly lower after the follow-up period (p<0·05). No serious complications were observed.ConclusionsOur results highlight the safety and long-term benefits of HBOT on haemorrhagic radiation cystitis and other distressful bladder symptoms.

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

“…Ferreira et al . also showed a significant correlation ( P < 0.05) between the resolution of hematuria and a shorter interval between the onset of hematuria and initiation of HBOT, but not between the resolution of hematuria and a shorter interval between termination of RT and onset of haematuria . This correlation was not significant in two other studies …”

“…(after post‐hoc analysis and adjustment of significance levels for multiple comparisons) and Ferreira et al . could not identify a significant correlation between the number of sessions and treatment response …”

“…Ferreira et al . studied the negative predictive effect of other treatment modalities before HBOT, but found no significant correlation …”

“…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 .…”