1
|
Alpuim Costa D, Amaro CE, Nunes A, Cardoso JS, Daniel PM, Rosa I, Branco JV. Hyperbaric oxygen therapy as a complementary treatment for radiation proctitis: Useless or useful? – A literature review. World J Gastroenterol 2021; 27:4413-4428. [PMID: 34366613 PMCID: PMC8316904 DOI: 10.3748/wjg.v27.i27.4413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/02/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy (RT) is the backbone of multimodality treatment of more than half of cancer cases. Despite new modern RT techniques, late complications may occur such as radiation proctitis (RP). The natural history of RP is unpredictable. Minor symptoms may resolve spontaneously or require conservative treatment. On the other hand, for similar and uncomplicated clinical contexts, symptoms may persist and can even be refractory to the progressive increase in treatment measures. Over the last decades, an enormous therapeutic armamentarium has been considered in RP, including hyperbaric oxygen therapy (HBOT). Currently, the evidence regarding the impact of HBOT on RP and its benefits is conflicting. Additional prospective and randomised studies are necessary to validate HBOT’s effectiveness in the ‘real world’ clinical practice. This article reviewed the relevant literature on pathophysiology, clinical presentation, different classifications and discuss RP management including a proposal for a therapeutic algorithm with a focus on HBOT.
Collapse
Affiliation(s)
- Diogo Alpuim Costa
- Department of Haematology and Oncology, CUF Oncologia, Lisboa 1998-018, Portugal
- Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisboa 1649-020, Portugal
- Centro de Investigação Naval (CINAV), Portuguese Navy, Base Naval do Alfeite, Almada 2810-001, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Lisboa 1169-056, Portugal
| | - Carla Espiney Amaro
- Centro de Investigação Naval (CINAV), Portuguese Navy, Base Naval do Alfeite, Almada 2810-001, Portugal
- Department of Otorhinolaryngology, Hospital das Forças Armadas (HFAR), Lisboa 1649-020, Portugal
| | - Ana Nunes
- Department of Gastroenterology, Hospital das Forças Armadas (HFAR), Lisboa 1649-020, Portugal
| | - Joana Santos Cardoso
- Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisboa 1649-020, Portugal
- Department of Vascular Surgery, Centro Hospitalar Universitário de Lisboa Central, Hospital de Santa Marta, Lisboa 1169-024, Portugal
| | - Pedro Modas Daniel
- Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisboa 1649-020, Portugal
- Centro de Investigação Naval (CINAV), Portuguese Navy, Base Naval do Alfeite, Almada 2810-001, Portugal
- Department of Intensive Care Unit, Hospital das Forças Armadas (HFAR), Lisboa 1649-020, Portugal
| | - Isabel Rosa
- Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisboa 1649-020, Portugal
- Centro de Investigação Naval (CINAV), Portuguese Navy, Base Naval do Alfeite, Almada 2810-001, Portugal
- Department of General Surgery, Hospital das Forças Armadas (HFAR), Lisboa 1649-020, Portugal
| | - João Vieira Branco
- Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisboa 1649-020, Portugal
| |
Collapse
|
2
|
Wen CC, Hsu FC, Hu SI, Cheng YC. The deterioration of radiation proctitis after a course of acute urine retention successfully treated by argon plasma coagulation. JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/jmedsci.jmedsci_426_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
3
|
Clarke RE, Tenorio LMC, Hussey JR, Toklu AS, Cone DL, Hinojosa JG, Desai SP, Dominguez Parra L, Rodrigues SD, Long RJ, Walker MB. Hyperbaric Oxygen Treatment of Chronic Refractory Radiation Proctitis: A Randomized and Controlled Double-Blind Crossover Trial With Long-Term Follow-Up. Int J Radiat Oncol Biol Phys 2008; 72:134-143. [PMID: 18342453 DOI: 10.1016/j.ijrobp.2007.12.048] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 12/07/2007] [Accepted: 12/12/2007] [Indexed: 12/13/2022]
|
4
|
de Parades V, Bauer P, Marteau P, Chauveinc L, Bouillet T, Atienza P. Traitement non chirurgical des rectites radiques chroniques hémorragiques. ACTA ACUST UNITED AC 2007; 31:919-28. [DOI: 10.1016/s0399-8320(07)78299-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
5
|
Petersen S, Jongen J, Petersen C, Sailer M. Radiation-induced sequelae affecting the continence organ: incidence, pathogenesis, and treatment. Dis Colon Rectum 2007; 50:1466-74. [PMID: 17661143 DOI: 10.1007/s10350-007-0296-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Incontinence is a late complication that causes symptoms years after radiation treatment and is difficult to deal with; it poses a particular challenge for care-providing physicians. REVIEW This review looks at our current knowledge of the incidence, symptoms, and treatment of fecal incontinence induced by radiation treatment. An approximate estimation based on retrospective data suggests an incidence of fecal incontinence of up to one-third of patients. The mechanism that causes incontinence are changes in anal resting tone, squeeze pressure, and rectal volume or rectal compliance. The other associated aspects of incontinence include such further disorders as proctitis, colitis, and other disturbances involving the lower digestive tract. The therapeutic options mainly comprise the treatment of associated aspects, such as proctitis or diarrhea. CONCLUSION Surgical treatment should be the absolute exception. If the creation of a stoma is being considered, a resective procedure offering freedom from symptoms seems to be the more advantageous option.
Collapse
Affiliation(s)
- Sven Petersen
- Department of Surgery, Bethesda General Hospital Hamburg Bergedorf, Glindersweg 80, 21029, Hamburg, Germany.
| | | | | | | |
Collapse
|
6
|
AGRAWAL PP, BANSAL N, BAHADUR AK, SINGH K, RATHI AK. Management of chronic hemorrhagic radiation proctitis. Asia Pac J Clin Oncol 2007. [DOI: 10.1111/j.1743-7563.2006.00084.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
7
|
Garg AK, Mai WY, McGary JE, Grant WH, Butler EB, Teh BS. Radiation proctopathy in the treatment of prostate cancer. Int J Radiat Oncol Biol Phys 2007; 66:1294-305. [PMID: 17126204 DOI: 10.1016/j.ijrobp.2006.07.1386] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Revised: 06/13/2006] [Accepted: 07/06/2006] [Indexed: 12/13/2022]
Abstract
PURPOSE To compile and review data on radiation proctopathy in the treatment of prostate cancer with respect to epidemiology, clinical manifestations, pathogenesis, risk factors, and treatment. METHODS Medical literature databases including PubMed and Medline were screened for pertinent reports, and critically analyzed for relevance in the scope of our purpose. RESULTS Rectal toxicity as a complication of radiotherapy has received attention over the past decade, especially with the advent of dose-escalation in prostate cancer treatment. A number of clinical criteria help to define acute and chronic radiation proctopathy, but lack of a unified grading scale makes comparing studies difficult. A variety of risk factors, related to either radiation delivery or patient, are the subject of intense study. Also, a variety of treatment options, including medical therapy, endoscopic treatments, and surgery have shown varied results, but a lack of large randomized trials evaluating their efficacy prevents forming concrete recommendations. CONCLUSION Radiation proctopathy should be an important consideration for the clinician in the treatment of prostate cancer especially with dose escalation. With further study of possible risk factors, the advent of a standardized grading scale, and more randomized trials to evaluate treatments, patients and physicians will be better armed to make appropriate management decisions.
Collapse
Affiliation(s)
- Amit K Garg
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | | |
Collapse
|
8
|
Girnius S, Cersonsky N, Gesell L, Cico S, Barrett W. Treatment of refractory radiation-induced hemorrhagic proctitis with hyperbaric oxygen therapy. Am J Clin Oncol 2006; 29:588-92. [PMID: 17148996 DOI: 10.1097/01.coc.0000236004.95384.5b] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the efficacy of hyperbaric oxygen therapy in treatment of severe refractory radiation-induced hemorrhagic proctitis. METHODS Nine patients with median age 75 (range, 66-83) treated with hyperbaric oxygen (HBO) at University of Cincinnati were reviewed. Pre- and post-therapy bleeding was graded on a 5-point scale. Five patients had previous hospitalizations for anemia and required transfusions. Three patients had undergone electrocautery or argon plasma coagulation before hyperbaric oxygen therapy (HBOT). The remainder had medical therapy before HBO. No patients experienced resolution of symptoms before HBO. The median follow-up after HBO was 17 months (range, 1-77). RESULTS Seven patients had complete resolution of rectal bleeding. Two patients exhibited a partial response, but continued to experience intermittent bleeding. The Wilcoxon signed rank test determined that HBOT significantly reduced rectal bleeding. CONCLUSIONS HBOT is a very effective treatment of hemorrhagic radiation-induced proctitis.
Collapse
|
9
|
Jones K, Evans AW, Bristow RG, Levin W. Treatment of radiation proctitis with hyperbaric oxygen. Radiother Oncol 2005; 78:91-4. [PMID: 16337705 DOI: 10.1016/j.radonc.2005.11.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Revised: 10/17/2005] [Accepted: 11/10/2005] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Radiation proctitis is a potential complication following pelvic radiation therapy. There are no standard treatments and treatment outcomes are unpredictable. We report our experience with the use of hyperbaric oxygen treatment (HBOT) for radiation proctitis cases refractory to standard medical or laser therapy. PATIENTS AND METHODS During the period 2000-2004, 10 patients with radiation proctitis were treated with HBOT (three males and seven females; mean age of 65). The median follow-up period was 25 months (range 6-43 months). Patient symptoms were retrospectively scored prior to, and following HBOT, based on the LENT-SOMA scale. RESULTS Prior to treatment, three patients had Grade 3 toxicity (i.e. requiring blood transfusions) and seven had Grade 2 toxicity with dominant symptoms of rectal pain and/or diarrhoea. HBOT was well tolerated and 9 of the 10 patients completed a full HBOT treatment program. Rectal bleeding completely stopped in four of nine symptomatic patients and improved in three others. Rectal pain completely remitted in three of five symptomatic patients. Diarrhea remitted completely in one of five patients and improved in three others. Of the 10 patients treated, only two did not respond to HBOT. CONCLUSIONS Significant improvement of rectal bleeding, diarrhea and rectal pain is possible using HBOT. HBOT should be offered to patients who fail conventional treatments for radiation proctitis.
Collapse
Affiliation(s)
- Kurian Jones
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ont., Canada
| | | | | | | |
Collapse
|
10
|
Pasquier D, Hoelscher T, Schmutz J, Dische S, Mathieu D, Baumann M, Lartigau E. Hyperbaric oxygen therapy in the treatment of radio-induced lesions in normal tissues: a literature review. Radiother Oncol 2004; 72:1-13. [PMID: 15236869 DOI: 10.1016/j.radonc.2004.04.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2004] [Accepted: 04/29/2004] [Indexed: 11/29/2022]
Abstract
Late complications are one of the major factors limiting radiotherapy treatment, and their treatment is not codified. Hyperbaric oxygen (HBO) has been used in combination with radiotherapy for over half a century, either to maximise its effectiveness or in an attempt to treat late complications. In this latter case, retrospective trials and case reports are prevailing in literature. This prompted European Society for Therapeutic Radiotherapy and Oncology and European Committee for Hyperbaric Medicine to organise a consensus conference in October 2001, dealing with the HBO indications on radiotherapy for the treatment and prevention of late complications. This updated literature review is part of the documents the jury based its opinion on. A systematic search was done on literature from 1960 to 2004, by only taking into account the articles that appeared in peer review journals. Hyperbaric oxygen treatment involving complications to the head and neck, pelvis and nervous system, and the prevention of complications after surgery in irradiated tissues have been studied. Despite the small number of controlled trials, it may be indicated for the treatment of mandibular osteoradionecrosis in combination with surgery, haemorrhagic cystitis resistant to conventional treatments and the prevention of osteoradionecrosis after dental extraction, whose level of evidence seems to be the most significant though randomised trials are still necessary. The other treatment methods are also outlined for each location.
Collapse
Affiliation(s)
- David Pasquier
- Department of Radiotherapy, Centre Oscar Lambret, 59020 Lille, France
| | | | | | | | | | | | | |
Collapse
|
11
|
Cotti G, Seid V, Araujo S, Souza AHSE, Kiss DRR, Habr-Gama A. Conservative therapies for hemorrhagic radiation proctitis: a review. ACTA ACUST UNITED AC 2003; 58:284-92. [PMID: 14666326 DOI: 10.1590/s0041-87812003000500008] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Chronic radiation proctitis represents a challenging condition seen with increased frequency due to the common use of radiation for treatment of pelvic cancer. Hemorrhagic radiation proctitis represents the most feared complication of chronic radiation proctitis. There is no consensus for the management of this condition despite the great number of clinical approaches and techniques that have been employed. Rectal resection represents an available option although associated with high morbidity and risk of permanent colostomy. The effectiveness of nonoperative approaches remains far from desirable, and hemorrhagic recurrence represents a major drawback that leads to a need for consecutive therapeutic sessions and combination of techniques. We conducted a critical review of published reports regarding conservative management of hemorrhagic chronic radiation proctitis. Although prospective randomized trials about hemorrhagic radiation proctitis are still lacking, there is enough evidence to conclude that topical formalin therapy and an endoscopic approach delivering an argon plasma coagulation represent available options associated with elevated effectiveness for interruption of rectal bleeding in patients with chronic radiation proctitis.
Collapse
Affiliation(s)
- Guilherme Cotti
- Department of Gastroenterology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo/SP, Brazil
| | | | | | | | | | | |
Collapse
|
12
|
Sminia P, van der Kleij AJ, Carl UM, Feldmeier JJ, Hartmann KA. Prophylactic hyperbaric oxygen treatment and rat spinal cord re-irradiation. Cancer Lett 2003; 191:59-65. [PMID: 12609710 DOI: 10.1016/s0304-3835(02)00621-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Normal tissue injury may lead to severe, life threatening, late side effects after therapeutic use of irradiation. Neurological complications caused by radiation of the spinal cord are ascribed to progressive, irreversible damage to the vasculature. Hyperbaric oxygen (HBO) is known to induce angiogenesis in irradiated tissue and has been proven to reduce late radiation injury in several normal tissues when applied during the latent period before complications become manifest. In the present study: (1). the prophylactic potential of HBO; (2). optimal timing of HBO therapy after spinal cord irradiation, i.e. during the latent period; and (3). effect of HBO on the re-irradiation tolerance of the spinal cord were investigated. The rat cervical spinal cord was locally X-ray irradiated with ten fractions of 6.5 Gy in 11 days. Five treatment groups (n=10) included: irradiation alone and irradiation followed by 30 HBO treatments (100% oxygen at 240 kPa for 90 min) during latency, with HBO starting either immediately, 5, 10 or 15 weeks after the primary irradiation course. One year after the primary treatment, the same spinal cord volume was re-irradiated with 20 Gy single dose. During life span, the animals were observed on the incidence of myelitis and the duration of the latent period. The actuarial analysis revealed no significant difference in neurological complications free survival between the irradiation alone and the irradiation+HBO treatment groups. A tendency towards radiosensitization was found in the group in which the primary irradiation course was immediately followed by the HBO treatment course. The data show that HBO applied during the latent period of progressively developing irradiation damage to the spinal cord does not increase the re-irradiation tolerance of this tissue.
Collapse
Affiliation(s)
- Peter Sminia
- Department of Radiation Oncology, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands,
| | | | | | | | | |
Collapse
|
13
|
Mayer R, Klemen H, Quehenberger F, Sankin O, Mayer E, Hackl A, Smolle-Juettner FM. Hyperbaric oxygen--an effective tool to treat radiation morbidity in prostate cancer. Radiother Oncol 2001; 61:151-6. [PMID: 11690680 DOI: 10.1016/s0167-8140(01)00430-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE We report the results of hyperbaric oxygen therapy (HBO) used in the treatment of radiation cystitis and proctitis following irradiation of prostate cancer. MATERIALS AND METHODS Between June 1995 and March 2000, 18 men (median age 71 years) with radiation proctitis (n=7), cystitis (n=8), and combined proctitis/cystitis (n=3) underwent HBO therapy in a multiplace chamber for a median of 26 sessions (range 2-60). The treatment schedule (2.2-2.4 atmospheres absolute, 60 min bottom time, once-a-day, 7 days a week) was set at a lower limit of 20 sessions; the upper limit was left open to symptom-related adjustment. Prior to HBO treatment, RTOG/EORTC late genitourinal (GU) morbidity was Grade 2 (n=3), Grade 3 (n=6) or Grade 4 (n=2); modified RTOG/EORTC late gastrointestinal (GI) morbidity was either Grade 2 (n=4) or Grade 3 (n=6). RESULTS Sixteen patients underwent an adequate number of sessions. RTOG/EORTC late GU as well as modified GI morbidity scores showed a significant improvement after HBO (GI, P=0.004; GU, P=0.004; exact Wilcoxon signed rank test); bleeding ceased in five out of five patients with proctitis and in six out of eight patients with cystitis; one of those two patients, in whom an ineffective treatment outcome was obtained, went on to have a cystectomy. CONCLUSIONS HBO treatment seems to be an effective tool to treat those patients with late GI and GU morbidity when conventional treatment has led to unsatisfactory results. Particularly in patients with radiation cystitis, HBO should not be delayed too long, as in the case of extensive bladder shrinkage improvement is hard to achieve.
Collapse
Affiliation(s)
- R Mayer
- Department of Radiotherapy, University Medical School of Graz, Auenbruggerplatz 32, A-8036 Graz, Austria
| | | | | | | | | | | | | |
Collapse
|