Hyperbaric oxygen therapy for radiation-induced cystitis and proctitis

Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):733-40. doi: 10.1016/j.ijrobp.2011.12.056. Epub 2012 Mar 21.


Purpose: 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 and materials: 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.

MeSH terms

  • Adolescent
  • Aged
  • Aged, 80 and over
  • Cystitis / etiology
  • Cystitis / therapy*
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / therapy
  • Hematuria / etiology
  • Hematuria / therapy*
  • Humans
  • Hyperbaric Oxygenation / adverse effects
  • Hyperbaric Oxygenation / methods*
  • Male
  • Middle Aged
  • Proctitis / etiology
  • Proctitis / therapy*
  • Radiation Injuries / complications
  • Radiation Injuries / therapy*
  • Retrospective Studies
  • Salvage Therapy / methods
  • Urinary Bladder Diseases / etiology
  • Urinary Bladder Diseases / therapy*