title: Is there a role for hyberbaric oxygen as primary treatment for grade IV radiation-induced haemorrhagic cystitis? A prospective pilot-feasibility study and review of literature.
abstract: OBJECTIVE
  To examine the safety and efficacy of hyperbaric oxygen as the primary treatment for Grade IV radiation-induced haemorrhagic cystitis.
  
  
  METHODS
  Hyperbaric oxygen was prospectively applied as a primary treatment option in 11 patients with Grade IV radiation cystitis. Primary endpoint was the incidence of complete and partial response to treatment. Secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival.
  
  
  RESULTS
  All patients completed therapy without complications for a mean follow-up of 17.82 months (range 3 to 34). Mean number of sessions needed was 32.8 (range 27 to 44). Complete and partial response rate was 81.8% and 18.2%, respectively. However, in three patients the first treatment session was not either sufficient or durable giving a 72.7% rate of durable effect. Interestingly, all 9 patients with complete response received therapy within 6 months of the haematuria onset compared to the two patients with partial response who received therapy at 8 and 10 months from the haematuria onset, respectively (p = 0.018). The need for blood transfusion (p = 0.491) and the total radiation dose (p = 0.259) were not correlated to success-rate. One patient needed cystectomy, while all patients were alive at the end of follow-up.
  
  
  CONCLUSIONS
  Early primary use of hyperbaric oxygen to treat radiation-induced grade IV cystitis is an effective and safe treatment option.
authors.affiliation: 2nd Surgical Department, University of Athens, Aretaieion Hospital, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Dellis
authors.affiliation: 2nd Urologic Department, University of Athens, Sismanoglio General Hospital, Athens, Greece.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Deliveliotis
authors.affiliation: Diving and Hyperbaric Oxygen Department, Naval and Veterans Hospital, Athens, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Kalentzos
authors.affiliation: Diving and Hyperbaric Oxygen Department, Naval and Veterans Hospital, Athens, Greece.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Vavasis
authors.affiliation: 2nd Urologic Department, University of Athens, Sismanoglio General Hospital, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Skolarikos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003556:Cystitis / Q000209:etiology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006417:Hematuria / Q000209:etiology / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000150:complications / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome