Terapia con oxígeno hiperbárico para la cistitis y la proctitis inducidas por la radioterapia

Abstract

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 prostateonly 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, 15e84 years). The range of externalbeam radiation delivered was 50.0e75.6 Gy. Bleeding must have been refractory to other therapies. Patients received 100% oxygen at 2.0 atmospheres absolute pressure for 90e120 min per treatment in a monoplace chamber. Symptoms were retrospectively scored according to the Late Effects of Normal TissuesdSubjective, 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 followup was 39months (range, 7e70 months). No cases of hematuria were refractory toHBOT. Complete resolution of hematuriawas seen in 81%(nZ9) and partial response in 18%(nZ2). Recurrence of hematuria occurred in 36%(nZ4) after a median of 10 months.Complete resolution of hematocheziawas seen in 50%(nZ2), partial response in 25%(nZ1), and refractory bleeding in 25%(nZ1).

Conclusions: Hyperbaric oxygen therapy is appropriate for radiation-induced HC once less timeconsuming therapies have failed to resolve the bleeding. In these conditions, HBOT is efficacious in the short and long term, with minimal side effects. _ 2012 Elsevier Inc.