title: Hyperbaric oxygen treatment in radiation-induced cystitis and proctitis: a prospective cohort study on patient-perceived quality of recovery.
abstract: OBJECTIVE
  In this prospective cohort study, the effects of hyperbaric oxygen treatment (HBOT) were evaluated concerning patient-perceived symptoms of late radiation-induced cystitis and proctitis secondary to radiation therapy for pelvic cancer.
  
  
  METHODS
  Thirty-nine patients, 35 men and 4 women with a mean age of 71 (range, 35-84) years were included after informed consent and institutional ethics approval. They had all been treated with radiation therapy for prostate (n=34), cervix (n=2), or rectal (n=3) cancer using external beam radiation at a dose of 25 to 75 Gy. Patients with hematuria requiring blood transfusion were excluded. The HBOT was delivered with 100% oxygen for 90 minutes at 2.0 to 2.4 atmospheres (ATA). Mean number of treatments was 36 (28-40). Symptoms were prospectively assessed using the Expanded Prostate Index Composite score before, during, and 6 to 12 months after HBOT.
  
  
  RESULTS
  The HBOT was successfully conducted, and symptoms were alleviated in 76% for patients with radiation cystitis, 89% for patients with radiation proctitis, and 88% of patients with combined cystitis and proctitis. Symptom reduction was demonstrated by an increased Expanded Prostate Index Composite score in the urinary domain from 50±16 to 66±20 after treatment (P<.001) and in the bowel domain from 48±18 to 68±18 after treatment (P<.001). For 31% of the patients with cystitis and 22% with proctitis, there were only trivial symptoms after HBOT. The improvement was sustained at follow-up in both domains 6 to 12 months after HBOT. No severe side effects were observed related to HBOT, and treatment compliance was high.
  
  
  CONCLUSIONS
  HBOT can be an effective and safe treatment modality for late radiation therapy-induced soft tissue injuries in the pelvic region.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: nicklas.oscarsson@vgregion.se.
authors.forename: Nicklas
authors.initials: N
authors.lastname: Oscarsson
authors.forename: Per
authors.initials: P
authors.lastname: Arnell
authors.forename: Pär
authors.initials: P
authors.lastname: Lodding
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Ricksten
authors.forename: Heléne
authors.initials: H
authors.lastname: Seeman-Lodding
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003556:Cystitis / Q000209:etiology / Q000628:therapy*; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D011349:Proctitis / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011832:Radiation Injuries / Q000150:complications / Q000628:therapy*; D011879:Radiotherapy Dosage; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000532:radiotherapy; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy