Hyperbaric oxygen therapy

Several authors have studied the use of hyperbaric oxygen in patients with radiation cystitis174'178'206-221 (Table 2.2.8-3). Bevers206 reported a prospective study of 40 patients; most of them required transfusion. Patients had received unsuccessful treatments: clot evacuation, electrocoagulation, alum, tranexamic acid. They received 20 sessions of 100% oxygen at 3 bar pressure for 90 minutes, 5 or 6 times a week. In 4 patients, 40 sessions were given because of persistence of symptoms. Hematuria stopped in 30 patients; occasional slight hematuria persisted in 7 patients; with a median follow up of 23 months, 9 recurrences occurred. The severity of initial hematuria appeared to influence the response to hyperbaric oxygen; failure of treatment was seen only in patients with a very severe hemorrhagic cystitis (3 patients with a mean blood transfusion need of 26 units ). Lee211 reported a retrospective study of 20 patients. They received an average of 44 sessions (2.5 ata, 100 minutes/session). Bleeding stopped in 16 patients, and markedly decreased in 2, with a mean follow-up of 14 months. However Del Pizzo209 reported worse results with a long term follow-up. With a median follow-up of 2.5 years, 8 of 11 patients were asymptomatic (3 had required urinary diversion), but with a median follow-up of 5 years only 3 had complete resolution of their symptoms (8 had been treated with surgery).

The majority of these studies do not use a toxicity scale, which renders their comparison difficult. Although there is no randomised study, the results of one prospective study and several retrospective studies suggest that HBO is effective, leads to a high rate of bladder preservation and has few side effects. These conclusions tally with those of a literature review published by Feldmeier222. However, these results should be verified with controlled, randomised trials to obtain the highest level of evidence level.

Table 2.2.8-3. Results of HBO in the treatment of radiogenic late bladder complications

Authors N Study design

Symptoms

HBO2 sessions pressure

Results

Follow up (months)

Chong 2005 60 Retrospective Haemorrhagic cystitis

Bui 2004 6 Retrospective

Corman208 2003 62 Retrospective

RTOG grade 3 patients <3 3 patients >3 Haemorrhagic cystitis

Mayer178 2001 11 Retrospective

Hendricks 20 Retrospective

2000

Mathews 1999 17 Retrospective

Del Pizzo 9 1998 11 Retrospective

Radiation cystitis (macroscopic hematuria in 8 patients) RTOG grade Grade 2: 2 patients, Grade 3: 6 patients, Grade 4: 2 patients

Cystitis

Haemorrhagic cystitis (blood transfusion in 8 patients)

35 2 ata

Haemorrhagic cystitis (blood transfusion in all patients)

Hematuria stopped in 96% of cases 88% with durable improvement

Complete response : 21 patients Partial response :

28 patients Failure: 8 patients Grade 0: 2 patients, Grade 1: 4 patients, Grade 2: 2 patients, Grade 3: 1 patient, Grade 4: 1patient. P=0.004 Complete response: 14 patients, failure: 6 patients Complete response : 11 patients, partial response : 2 patients, microscopic haematuria: 2 patients, failure: 2 patients Complete response: 3 patients, complete response followed by

(median)

recurrence:

Table 2.2.8-3. Continued

Authors

N

Study design

Symptoms

HBO2 sessions pressure

Results

Follow up (months)

5 patients,

failure: 3 patients

Bevers

40

Prospective

Haemorrhagic cystitis

20 (40

Complete or

23

1995

(blood transfusion in 30

sessions

partial response:

(mean)

patients)

in 4

37 patients

patients)

3 ata

Lee211

20

Retrospective

Haemorrhagic cystitis in

44 (mean)

Complete

14

1994

19 patients,

2.5 ata

response:

(mean)

radiation cystitis

16 patients,

without haematuria in 1

partial response:

patient

2 patients, failure:

1 patient,

radiation cystitis

without

haematuria:

complete

response

Weiss219

13

Retrospective

Haemorrhagic cystitis

60

Complete

30

1994

(blood

2 ata

response:

(mean)

transfusion in 9 patients)

12 patients

Nakada214 1992

6

Retrospective

Haemorrhagic cystitis

45

Complete

NS

2 ata

response:

5 patients

Rijkmans216 1989

10

Retrospective

Haemorrhagic cystitis

20

Complete

7

3 ata

response:

6 patients

ata = atmosphere absolute

NS = Not Specified

0 0

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