Hyperbaric Oxygen Therapy

Radiation Proctitis

HBOT is approved for the treatment of Radiation Proctitis

Radiation proctitis is inflammation of the rectum caused by radiation therapy, often used to treat pelvic cancers. It can manifest as acute or chronic symptoms. Acute radiation proctitis, which occurs during or shortly after treatment, can include diarrhea, urgency, and mucus discharge. Chronic radiation proctitis, which can develop months or years later, may cause rectal bleeding, pain, and strictures.

Radiation proctitis signs and symptoms include:

Abdominal Cramping: Pain in the abdomen, especially during bowel movements.
Mucoid Discharge: Mucus discharge from the rectum.
Fecal Urgency: A sudden and strong urge to defecate.
Anorectal Dysfunction: Difficulty controlling bowel movements or fecal incontinence.
Diarrhea: Frequent loose stools, sometimes with blood.
Rectal Bleeding: Blood in the stool or on toilet paper.
Tenesmus: A persistent and urgent feeling of needing to have a bowel movement, even when the bowels are empty.
Rectal Pain and/or Cramping: Discomfort in the rectum or lower abdomen.

Studies on Radiation Proctitis and HBOT

The effectiveness of hyperbaric oxygen therapy for managing radiation-induced proctitis– results of a 10-year retrospective cohort study

Antonio Moreira Monteiro 1 *†, Diogo Alpuim Costa1,2,3,4,5 *†, Virgı´nia Mareco 6 and Carla Espiney Amaro3 1Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal, 2NOVA Medical School, Faculdade de Cieˆ ncias Me´ dicas, Lisbon, Portugal, 3Centro de Medicina Subaqua´ tica e Hiperba´ rica (CMSH), Armed Forces Hospital, Lisbon, Portugal, 4Medical Oncology Department, Hospital de Cascais Dr. Jose´ de Almeida, Alcabideche, Portugal, 5Hematology and Oncology Department, CUF Oncologia, Lisbon, Portugal, 6Radiotherapy Department, Hospital de Santa Maria, Centro Hospitalar Universita´ rio

Lisboa Norte, Lisbon, Portugal

Introduction: Despite modern radiotherapy (RT) techniques, radiation-induced

proctitis (RIP) remains a signi cant complication of RT for pelvic organ

malignancies. Over the last decades, an enormous therapeutic armamentarium

has been considered in RIP, including hyperbaric oxygen therapy (HBOT).

However, the evidence regarding the impact of HBOT on RIP is con icting.

This study aims to evaluate the effectiveness and safety of HBOT in the treatment

of RIP.

Methods: Ten-year (2013-2023) retrospective analysis of all consecutive patients

with RIP treated with HBOT at Centro de Medicina Subaquática e Hiperbárica

(CMSH) (Armed Forces Hospital– Lisbon, Portugal). Patients were exposed to

100% oxygen at 2.5 ATA, in a multiplace rst-class hyperbaric chamber, for 70-

min periods, once daily, ve times per week. Fisher’s exact test was performed

using SPSS (version 23.0); p<0.05 was accepted as statistically signi cant.

Results: Of a total of 151 patients with RIP, 88 were included in the nal analysis,

of whom 38.6% evidenced other concurrent radiation-induced soft tissue

lesions. The most reported primary pelvic tumor treated with RT was prostate

cancer (77.3%), followed by cervical cancer (10.2%). Hematochezia was the most

observed clinical manifestation (86.4%). After a median of 60 HBOT sessions

(interquartile range [IQR]: 40-87.5), 62.5% and 31.8% of patients achieved a

clinical complete and partial response, respectively, with a hematochezia

resolution rate of 93.7% (complete or partial). While partial and complete

responses require fewer than 70 sessions of HBOT in terms of overall RIP

symptoms (p=0.069), isolated hematochezia tends to require at least 70

sessions (p=0.075). Individuals with at least two concurrent late radiation tissue

injuries were associated with a complete response to HBOT (p=0.029). Only

about 5.7% of patients did not respond to the treatment. Eighteen patients

(20.5%) developed reversible ear barotrauma. The number of HBOT sessions

was a predictor of HBOT side effects (odds ratio: 1.010; 95% con 1.000-1.020; p=0.047).

dence interval,

Conclusion: The HBOT proved to be an effective and safe treatment for RIP

refractory to medical and/or endoscopic treatments. This real-world evidence

study adds value to published data on the management of RIP with HBOT.

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Hyperbaric Oxygen Therapy

Radiation Proctitis

HBOT is approved for the treatment of Radiation Proctitis

Studies on Radiation Proctitis and HBOT