Hyperbaric oxygen therapy HBO

The first case of hemorrhagic radiation proctitis treated by HBO has been

reported in 1991. Others retrospective trials report its efficiency -(Table 2.2.8-2). Warren181, in 14 patients, found complete resolution of symptoms in 8, and one had improvement (with a median follow up of 17 months). A trial included 18 patients with radiation proctitis; most of them have been treated for prostate carcinoma. Most had failed previous therapies: steroids183, formalin158. The average number of session was 24 (2 Atmosphere Absolute (ata), 105'/session, 6 days a week). Before HBO 17 patients complained bleeding: in 4 of these it stopped completely, and three had partial improvement. About 50 % of patients improved (bleeding, incontinence, diarrhoea, pain)182. The largest study included 36 patients; toxicity was recorded with the SOMA-LENT system. The score was 1 in 1 patient, 2 in 11 patients, 3 and 4 in 16 and 8 patients. Complete response was defined as the disappearance of symptoms and endoscopic lesions, while partial response was defined as a decrease of at least one point to the SOMA LENT score and failure was described as a stagnant or worsened score. The long-term results were able to be evaluated in 32 patients. With a mean follow-up of 52 months, a complete or partial response was observed in 21 patients176. HBO has been successfully used in few cases of duodenal and rectal ulceration too173'184. Nevertheless, no controlled study was published and the level of evidence of HBO beneficial action is weakly supported.

Table 2.2.8-2. Results of HBO in the treatment of radiogenic late rectal complications

Authors

N

Study design

sessions pressure

Results

Follow up (months)

Bui174

18

Retrospective

RTOG grade

40 (20-60)

22% with durable

72

2004

14 patients <3 4 patients >3

2,4 ata

improvement

Mayer178

10

Retrospective

80% failure of

27 (18-60)

Improvement of 1,7

14

2001

previous treatments

2,4 ata

points in RTOG/EORTC scale

(2.251.6)

Bem173

2

Case

Refractory severe

60 sessions at

Patients healed

3 and 48

2000

study

pain, tenesmus, bleeding

2,4 ata

Table 2.2.8-2. Continued

Authors

N

Study design

Symptoms

HBO2

Results

Follow

sessions

up

pressure

(months)

Kitta177

4

Retrospective

3 patients with

3 patients had

Significant

11-13

2000

moderate to

30 sessions, 1

improvement in

severe bleeding,

had 60 at 2,0

bleeding and

typical

ata (only 60'

rectoscopy findings for

rectoscopy

for each

all patients, one patient

findings, one had

session)

had a bleeding relapse

severe proctalgia

after 3 months, no

change with the patient

with proctalgia

Gouëllo176

36

Retrospective

All refractory, 9

67 (12-198),

9 healed,

52

1999

chronic wounds,

2,5 ata

12 improved,

(2-120)

19 rectorrhagia, 9

11 failed.

profuse diarrheas

Warren181

14

Retrospective

Symptoms were

40 ( 20-72),

9 patients healed,

16 (2-35)

1997

refractory in 11

2,0 ata in

3 patients improved

patients, 11 had

monoplace

and relapsed by end of

rectorrhagia, 5

chamber, 2,4

follow up, 2 did not

diarrhea, 5

ata in

respond at all.

tenesmus or

multiplace

colic.

chamber

Woo182

18

Retrospective

All refractory,

24 (12-40)

7 rectorrhagias, 2 pain,

14 (3-65)

1997

17 rectorrhagia, 4

2,0 ata

3 incontinence and 4

pain,

diarrhea improved or

4 incontinence, 8

healed

diarrhea

Nakada180

1

Case study

Severe

30, 2,0 ata

Cessation of

NS

1993

rectorrhagia

rectorrhagia and

reversal of histological

findings

ata = atmosphere absolute NS = Not Specified

0 0

Post a comment