Elsevier

Urology

Volume 65, Issue 4, April 2005, Pages 649-653
Urology

Adult urology
Early hyperbaric oxygen therapy improves outcome for radiation-induced hemorrhagic cystitis

https://doi.org/10.1016/j.urology.2004.10.050Get rights and content

Abstract

Objectives

To assess the clinical factors that affect the efficacy of hyperbaric oxygen (HBO2) therapy in treating radiation-induced hemorrhagic cystitis. HBO2 therapy is an effective treatment for radiation-induced hemorrhagic cystitis, with reported response rates ranging from 76% to 100%.

Methods

The data from patients with radiation-induced hemorrhagic cystitis treated at our institution between May 1988 and December 2001 were reviewed retrospectively. All patients received HBO2 therapy at 2.36 atm absolute pressure, with 90 minutes of 100% oxygen breathing per treatment. The outcome was assessed after at least 12 months of follow-up. We evaluated patient demographics, types of pelvic malignancy and radiotherapy, total radiation dose, onset and severity of hematuria, and prior intravesical management. Clinical improvement was defined as the absence of, or reduction in, macroscopic hematuria.

Results

A total of 60 patients (55 men and 5 women), mean age 70 years, received an average of 33 HBO2 treatments (range 9 to 63). Of the 60 patients, 48 (80%) had either total or partial resolution of hematuria. When treated within 6 months of hematuria onset, 96% (27 of 28) had complete or partial symptomatic resolution (P = 0.003). All 11 patients with previous clot retention had clinical improvement if treated within 6 months of hematuria onset (P = 0.007). Prior intravesical chemical instillation did not affect the clinical outcome. Patients who had undergone primary, adjuvant, or salvage external beam pelvic radiotherapy showed response rates of 81%, 83%, and 78%, respectively (P = 0.950).

Conclusions

Our results show that delivery of HBO2 therapy within 6 months of hematuria onset is associated with a greater therapeutic response rate. Treatment efficacy was independent of prior intravesical therapy and the timing of radiotherapy.

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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