Adult urologyEarly hyperbaric oxygen therapy improves outcome for radiation-induced hemorrhagic cystitis
Section snippets
Material and methods
The data of patients treated with HBO2 for radiation-induced HC at our institution between May 1988 and December 2001 were retrospectively reviewed. All patients had negative urine cultures and underwent pretreatment cystoscopic evaluation to exclude bladder malignancy and to document the presence of radiation cystitis.
Patients received HBO2 therapy in a multiplace hyperbaric chamber with 90 minutes of 100% oxygen breathing at 2.36 atm absolute pressure per session, including 5-minute air
Results
A total of 60 patients (55 men and 5 women) with a mean age of 70 years (range 15 to 88) received an average of 33 HBO2 treatments (range 9 to 63). Patients with complete resolution, partial resolution, no change, and worsened hematuria had an increasing mean age of 69, 70, 75, and 80 years, respectively. Of the 60 patients, 44 men and 4 women (80%) had either complete or partial resolution of macroscopic hematuria (Table II). In our series, the most common indication for pelvic radiotherapy
Comment
Radiation-induced HC is an uncommon, but potentially devastating, side effect of pelvic radiotherapy. Of 1784 patients treated with radiotherapy for Stage Ib cervical cancer, the actuarial lifetime risk of major RTOG/EORTC grade 3 or worse urinary radiation morbidity has been reported at 1.0% at 5 years, 1.4% at 10 years, and 2.3% at 20 years.10 Historically, severe HC was associated with a 44% mortality rate despite aggressive urinary diversion and cystectomy.11
Radiation-induced tissue
Conclusions
In our study, delivery of HBO2 therapy within 6 months of the onset of hematuria was associated with an increased therapeutic response rate, even in patients with a history of clot retention. The effectiveness of the treatment was independent of prior intravesical therapy and the timing of radiotherapy.
Acknowledgment
To Helen Phelps at Virginia Mason Medical Center for her statistical expertise.
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