HBOT is approved for the treatment of Radiation Cystitis

Hyberbaric oxygen as sole treatment for severe radiation induced haemorrhagic cystitis

Athanasios Dellis 1, Athanasios Papatsoris 2, Vasileios Kalentzos 3, Charalambos Deliveliotis 2, Andreas Skolarikos 2, 1 2nd Department of Surgery, National and Kapodistrian University of Athens, Aretaieion Academic Hospital, Greece; 2 2nd Department of Urology, University of Athens, Sismanoglio General Hospital,

Athens, Greece; 3 Department of Diving and Hyperbaric Oxygen, Naval and Veterans Hospital, Athens, Greece

 

​

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 re-

sponse 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

Lauren Villeirs,1 Thomas Tailly,1,2 Piet Ost,1,3 Marjan Waterloos,1,2,4 Karel Decaestecker,1,2 Valerie Fonteyne,1,3 Charles Van Praet1,2 and Nicolaas Lumen1,2

1Faculty of Medicine and Health Sciences, Ghent University, 2Department of Urology, 3 Department of Radiation Oncology, Ghent University Hospital, and 4Department of Urology, General Hospital Maria Middelares, Ghent, Belgium

​

​Abstract

The present study assessed the efficacy of hyperbaric oxygen therapy in reducing symptoms of radiation cystitis, a specific type of iatrogenic injury to the bladder, by systematic review of recent literature. The MEDLINE, Embase and Web of Science databases were searched using combinations of the terms “radiation,” “cystitis” and “hyperbaric oxygen” to identify articles evaluating patients with radiation cystitis, treated with hyperbaric oxygen therapy. Only recent (≤10 years) original studies were included. Data were extracted and pooled in order to calculate descriptive weighted averages. Articles were evaluated on their level of evidence. A total of 20 papers were obtained, resulting in a cohort of 815 patients who were treated with hyperbaric oxygen therapy for radiation cystitis. Overall and complete response rates varied from 64.8% to 100% and 20% to 100%, respectively. The weighted average overall and complete response rates were 87.3% and 65.3%, respectively. Adverse events were observed in 9.6% of the patients, but permanent side-effects were rare. The most prominent limitations were high cost and low availability. Hyperbaric oxygen therapy is effective in the treatment of radiation-induced cystitis, with minimal adverse events, but low availability and high cost. At present, evidence is low; therefore, more prospective studies are required.

​

​

Narrative review of hyperbaric oxygen therapy for radiation induced hemorrhagic cystitis

Robert Dieu1, Kevin Heinsimer2^1 Morsani College of Medicine, University of South Florida, Tampa, FL, USA; 2Department of Urology, University of South Florida, Tampa, FL, USA Contributions: (I) Conception and design: Both authors; (II) Administrative support: Both authors; (III) Provision of study materials or patients: Both authors; (IV) Collection and assembly of data: Both authors; (V) Data analysis and interpretation: Both authors; (VI) Manuscript writing: Both authors; (VII) Final approval of manuscript: Both authors.

​

Abstract: To evaluate the benefits of hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis (HC). Hyperbaric oxygen has been shown to be an effective long-term treatment for early and late radiation- and chemotherapy-induced HC. It has been proven safe for adult and pediatric patients. Treatment typically required 10–40 “dives” for 60–120 min, making it very time intensive for patients. Complete response has been reported in up to 87% of patients with recurrence ranging from 0–35% in most studies. It works both as an initial treatment and after less time-intensive therapies have failed. Better responses have been seen with initiation within 6-month of presentation. Additional risk factors for treatment failure include: higher radiation doses, more severe hematuria, incomplete treatment, and blood thinner use. In addition to being effective for hematuria, it has also been shown to improve the lower urinary tract symptoms associated with radiation cystitis. Repeat treatments are effective for some patients,

but if hematuria fails to resolve after hyperbaric oxygen therapy (HBOT), patients must be reassessed for malignancy as a source of their hematuria. The overall complication rate is low, and these tend to be self-limited with the most common adverse effects being blurred vision and ear pain which resolve after treatment. While expensive and time intensive, it may prove to be cheaper in the long run and offer a better

alternative to patients otherwise facing bladder embolization or cystectomy.