Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial

Abstract

Introduction Cancer is affecting a growing number of persons. Still, the treatment and survival of cancer is improving. Radiation therapy is used in the treatment of cancer. Late radiation-induced injuries afflict 5-15% of irradiated patients. The urinary bladder and bowel may be affected after irradiation of cancer in the pelvic region. Symptoms can be severe, with impaired health related quality of life (HRQoL). Hyperbaric oxygen therapy (HBOT) involves breathing oxygen at high ambient pressure. HBOT can reverse radiation-induced injuries, alleviate patient-perceived symptoms, and improve HRQoL. We aimed to clarify the effects of HBOT on late radiation-induced injuries in the urinary bladder and bowel, and to clarify some of the underlying mechanisms through which HBOT exerts its effects. Methods A prospective cohort study assessed effects of HBOT on patient-perceived symptoms (Paper I). A rat study assessed reversal of radiation-induced stress with HBOT (Paper II). A methodological experiment assessed reversal of HBOT on cellular death induced by radiation (Paper III). A multi-center, randomized, controlled trial assessed patient-perceived symptoms, HRQoL, and objective clinical outcomes (Paper IV). Result HBOT can alleviate patient-perceived symptoms, reduce objective findings, and improve HRQoL in patients affected by late radiation-induced injuries (Paper I, IV). Oxidative stress and downstream effects, induced by the irradiation, can be reversed by HBOT (Paper II). Paper III outlines a method for studies on urothelial cells exposed to radiation and HBOT. Conclusion HBOT can reduce radiation-induced oxidative stress and inflammatory response. HBOT can reverse injuries induced by radiation therapy to the pelvic region, alleviate patient-perceived symptoms and lead to improved HRQoL.

Can hyperbaric oxygen safely serve as an anti-inflammatory treatment for COVID-19?

“…HBO 2 has been used for almost a century, initially for decompression sickness (DCS), but it was soon noted that it had several anti-inflammatory effects [10] , [11] . HBO 2 is shown to be effective in treatment of radiation injury [12] , [13] , [14] and wound healing [15] . In all cases, HBO 2 has been used with great safety, and with very few adverse effects.…”

Supportive care for toxicities in children undergoing radiation therapy

“…117 Studies of hyperbaric oxygen therapy for severe HRC demonstrate clinical response in >75% and complete resolution of hematuria in 59% to 96% of adults. [118][119][120][121] In refractory cases and acutely unstable patients, selective embolization of the anterior division of the internal iliac artery can be performed. 122,123 Rarely, severe or life-threatening cystitis may require urinary diversion with or without cystectomy.…”

Experiences of patients with pelvic radiation injuries after cancer treatment undergoing hyperbaric oxygen therapy: A phenomenological-hermeneutical study

“…[7][8][9][10][11] Treatment options are limited, but hyperbaric oxygen treatment (HBOT) has shown promising effects in treating pelvic LRTI. 1,2,[12][13][14] The aim of this treatment is to increase tissue oxygen concentrations and stimulate neoangogenesis and cellular regeneration, thereby revitalising and healing the hypoxic tissue and alleviating the symptom burden. 6,15 Hyperbaric oxygen treatment is a high-technology treatment where patients are enclosed in a pressurised chamber and breath pure oxygen at a pressure of 2 atmospheres absolute or more for 90-100 minutes once a day for 6-8 weeks.…”