title: Hyperbaric oxygen therapy for radiation-induced cystitis and proctitis.
abstract: OBJECTIVE
  To provide a retrospective analysis of the efficacy of hyperbaric oxygen therapy (HBOT) for treating hemorrhagic cystitis (HC) and proctitis secondary to pelvic- and prostate-only radiotherapy.
  
  
  METHODS
  Nineteen patients were treated with HBOT for radiation-induced HC and proctitis. The median age at treatment was 66 years (range, 15-84 years). The range of external-beam radiation delivered was 50.0-75.6 Gy. Bleeding must have been refractory to other therapies. Patients received 100% oxygen at 2.0 atmospheres absolute pressure for 90-120 min per treatment in a monoplace chamber. Symptoms were retrospectively scored according to the Late Effects of Normal Tissues-Subjective, Objective, Management, Analytic (LENT-SOMA) scale to evaluate short-term efficacy. Recurrence of hematuria/hematochezia was used to assess long-term efficacy.
  
  
  RESULTS
  Four of the 19 patients were lost to follow-up. Fifteen patients were evaluated and received a mean of 29.8 dives: 11 developed HC and 4 proctitis. All patients experienced a reduction in their LENT-SOMA score. After completion of HBOT, the mean LENT-SOMA score was reduced from 0.78 to 0.20 in patients with HC and from 0.66 to 0.26 in patients with proctitis. Median follow-up was 39 months (range, 7-70 months). No cases of hematuria were refractory to HBOT. Complete resolution of hematuria was seen in 81% (n = 9) and partial response in 18% (n = 2). Recurrence of hematuria occurred in 36% (n = 4) after a median of 10 months. Complete resolution of hematochezia was seen in 50% (n = 2), partial response in 25% (n = 1), and refractory bleeding in 25% (n = 1).
  
  
  CONCLUSIONS
  Hyperbaric oxygen therapy is appropriate for radiation-induced HC once less time-consuming therapies have failed to resolve the bleeding. In these conditions, HBOT is efficacious in the short and long term, with minimal side effects.
authors.affiliation: Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA19102, USA.
authors.forename: Caspian
authors.initials: C
authors.lastname: Oliai
authors.forename: Brandon
authors.initials: B
authors.lastname: Fisher
authors.forename: Ashish
authors.initials: A
authors.lastname: Jani
authors.forename: Michael
authors.initials: M
authors.lastname: Wong
authors.forename: Jaganmohan
authors.initials: J
authors.lastname: Poli
authors.forename: Luther W
authors.initials: LW
authors.lastname: Brady
authors.forename: Lydia T
authors.initials: LT
authors.lastname: Komarnicky
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D003556:Cystitis / Q000209:etiology / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy; D006417:Hematuria / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000209:etiology / Q000628:therapy*; D011832:Radiation Injuries / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000628:therapy*