30-Year Experience of Treating Refractory Radiation - Induced Hemorrhagic Cystitis with Hyperbaric Oxygen Therapy: A Retrospective Single-Centre Study
DOI:
https://doi.org/10.24915/apuj.279Keywords:
Cystitis, Hematuria, Hyperbaric Oxygenation, Radiation Injuries, Radiotherapy/adverse effectsAbstract
Introduction: Due to its considerable morbidity and mortality, radiation- induced hemorrhagic cystitis is an important complication of pelvic radiotherapy, with current conservative treatments having very limited effectiveness. Hyperbaric oxygen therapy is effective in the treatment of radiation- induced injuries, such as radiation- induced hemorrhagic cystitis. We aim to analyze the efficacy and safety profile of hyperbaric oxygen therapy in refractory hemorrhagic radical cystitis.
Methods: Retrospective analysis of the clinical records of 290 patients with refractory radiation- induced hemorrhagic cystitis treated with hyperbaric oxygen at our centre, between 1994 and 2022. The evolution of macroscopic hematuria was the parameter used to analyze the effectiveness of the treatment.
Results: In 14.8%14.8% of patients, other concomitant radiation- induced lesions were found, such as proctitis or enteritis. After an average of 37 sessions, 89.8%89.8% of patients had resolution of hematuria. Adverse effects were identified in 5.5%5.5% of patients. The need for blood transfusion and the time between radiotherapy and the appearance of macroscopic hematuria had a statistically significant correlation (p value <0.01<0.01 ) with the hematuria resolution rate.
Conclusion: Hyperbaric oxygen therapy was safe and effective in the treatment of refractory radiation- induced hemorrhagic cystitis. The presence of concomitant radiation- induced injuries was relatively common, which makes hyperbaric oxygen an excellent choice as an initial therapy in these patients.
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Martin SE, Begun EM, Samir E, Azaiza MT, Allegro S, Abdelhady M. Incidence and Morbidity of Radiation-Induced Hemorrhagic Cystitis in Prostate Cancer. Urology. 2019;131: 190-5. doi: 10.1016/j.urology.2019.05.034.
Lawton CA, Won M, Pilepich MV, Asbell SO, Shipley WU, Hanks GE, et al. Long-term treatment sequelae following external beam irradiation for adenocarcinoma of the prostate: analysis of RTOG studies 7506 and 7706. Int J Radiat Oncol Biol Phys. 1991;21:935-9. doi: 10.1016/0360-3016(91)90732-j.
Zwaans BM, Krueger S, Bartolone SN, Chancellor MB, Marples B, Lamb LE. Modeling of chronic radiation-induced cystitis in mice. Adv Radiat Oncol. 2016 Oct-Dec;1(4):333-343. doi: 10.1016/j.adro.2016.07.004.
Ribeiro de Oliveira TM, Carmelo Romão AJ, Simões de Oliveira PM, Silva Gaspar SR, Gamito Guerreiro FM, Matos Lopes TM. Hyperbaric oxygen therapy in hemorrhagic radical cystitis. Acta Urol Port. 2016;33:1-5. doi: 10.1016/j.acup.2016.02.001.
Ribeiro de Oliveira T, Amaro CD, Pereira SH, Castro AS, Monteiro PG, Felicio JC, et al. Development of a Novel Clinical Classification for Radiation-induced Cystitis: The Portuguese Navy Radiation-induced Cystitis (PNRC) Scale. Eur Urol Open Sci. 2024;71:193-9. doi: 10.1016/j.euros.2024.12.006.
Thom SR. Experimental use of hyperbaric oxygen therapy. J Emerg Med. 1985;3:65. doi: 10.1016/0736-4679(85)90222-7.
Feldmeier JJ, Hampson NB. A systematic review of the literature reporting the application of hyperbaric oxygen prevention and treatment of delayed radiation injuries: an evidence based approach. Undersea Hyperb Med. 2002;29:4-30.
Villeirs L, Tally T, Ost P, Waterloos M, Decaestecker K, Fonteyne V, et al. Hyperbaric oxygen therapy for radiation cystitis after pelvic radiotherapy: Systematic review of the recent literature. Int J Urol. 2020;27:98-107. doi: 10.1111/iju.14130.
Nakada T, Nakada H, Yoshida Y, Nakashima Y, Banya Y, Fujihira T, et al. Hyperbaric oxygen therapy for radiation cystitis in patients with prostate cancer: a long-term follow-up study. Urol Int. 2012;89:208-14. doi: 10.1159/000338910.
Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer. 2005;104:1129-37. doi: 10.1002/cncr.21324. Erratum in: Cancer. 2006;107:660.
Oliaci C, Fisher B, Jani A, Wong M, Poli J, Brady LW, Komarnicky LT. Hyperbaric oxygen therapy for radiation-induced cystitis and proctitis. Int J Radiat Oncol Biol Phys. 2012;84:733-40. doi: 10.1016/j.ijrobp.2011.12.056.
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