Hyperbaric Oxygen Treatment in Radiation-Induced Cystitis and Proctitis: A Prospective Cohort Study on Patient-Perceived Quality of Recovery

• DOI: 10.1016/j.ijrobp.2013.07.039
• Publication Date: 2013-09-11T03:50:37Z
• Authors: Nicklas Oscarsson; Per Arnell; Pär Lodding; Sven-Erik Ricksten; Heléne Seeman-Lod...
• Keywords: Adult; Aged, 80 and over; Male; Analysis of Variance; Hyperbaric Oxygenation; Rectal Neoplasms; Prostatic Neoplasms; Radiotherapy Dosage; Recovery of Function; Middle Aged; 3. Good health; Diagnostic Self Evaluation; 03 medical and health sciences; 0302 clinical medicine; Surveys and Questionnaires; Cystitis; Humans; Patient Compliance; Female; Proctitis; Prospective Studies; Radiation Injuries; Aged

In this prospective cohort study, the effects of hyperbaric oxygen treatment (HBOT) were evaluated concerning patient-perceived symptoms of late radiation-induced cystitis and proctitis secondary to radiation therapy for pelvic cancer.Thirty-nine patients, 35 men and 4 women with a mean age of 71 (range, 35-84) years were included after informed consent and institutional ethics approval. They had all been treated with radiation therapy for prostate (n=34), cervix (n=2), or rectal (n=3) cancer using external beam radiation at a dose of 25 to 75 Gy. Patients with hematuria requiring blood transfusion were excluded. The HBOT was delivered with 100% oxygen for 90 minutes at 2.0 to 2.4 atmospheres (ATA). Mean number of treatments was 36 (28-40). Symptoms were prospectively assessed using the Expanded Prostate Index Composite score before, during, and 6 to 12 months after HBOT.The HBOT was successfully conducted, and symptoms were alleviated in 76% for patients with radiation cystitis, 89% for patients with radiation proctitis, and 88% of patients with combined cystitis and proctitis. Symptom reduction was demonstrated by an increased Expanded Prostate Index Composite score in the urinary domain from 50±16 to 66±20 after treatment (P<.001) and in the bowel domain from 48±18 to 68±18 after treatment (P<.001). For 31% of the patients with cystitis and 22% with proctitis, there were only trivial symptoms after HBOT. The improvement was sustained at follow-up in both domains 6 to 12 months after HBOT. No severe side effects were observed related to HBOT, and treatment compliance was high.HBOT can be an effective and safe treatment modality for late radiation therapy-induced soft tissue injuries in the pelvic region.