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Ju Z, Yu W, Li Y, Han W, Tu X, Zhu S, Zou Q. The clinical research of 5 steps sequential method for whole treatment of hemorrhagic radiation cystitis in china. Int J Med Sci 2021; 18:756-762. [PMID: 33437210 PMCID: PMC7797551 DOI: 10.7150/ijms.47906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/19/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Curing hemorrhagic cystitis remains a challenge. We explore a continuous and effective treatment for hemorrhagic radiation cystitis. Methods: The data of patients in 6 provincial cancer hospital urology departments between April 2015 and December 2019 was reviewed retrospectively. Patients were classified as moderate and severe groups. The 5-steps sequential method was adopted. Two groups were initiated with step 1 and step 3 respectively. Step 1 was symptomatic treatment. Thrombin solution or sodium hyaluronate was administrated for bladder irrigation in step 2. Step 3 was transurethral electrocoagulation. Step 4 was interventional embolization. Step 5 was HBO therapy. OABSS was used to assess the improvement of patients' symptoms. The outcome was evaluated after at least 6 months of follow-up. Results: A total of 650 patients (56 men and 594 women), mean age 71.2 years, were enrolled in the 5 steps sequential method. 582 patients were classified as moderate and 68 severe group. In moderate group, the cure rate of step 1 was 61.2% (356/582), 80.4% (468/582) after step 2, 93.1% (542/582) after step 3, 96.2% (560/582) after step 4, and 99.8% (581/582) after step 5. In severe group, the cure rate was 54.4% (37/68) after step 3, 76.5% (52/68) after step 4, and 94.1% (64/68) after the step 5 respectively. The mean OABSS scores of both groups significantly decreased after 5 steps sequential method treatment (P<0.01). Conclusions: Our results show hemorrhagic radiation cystitis can be cured in 5 steps, and the 5 steps sequential method is welcomed and effective. Therapy efficacy depends on the number of steps adopted and the severity of hematuria.
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Affiliation(s)
- Zhenghua Ju
- Department of Urology, Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Wenchang Yu
- Department of Invasive Technology, Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Youyuan Li
- Department of Urology, Hubei Provincial Cancer Hospital, Wuhan, China
| | - Weiqing Han
- Department of Urology, Hunan Provincial Cancer Hospital, Changsha, China
| | - Xinhua Tu
- Department of Urology, Jiangxi Provincial Cancer Hospital, Nanchang, China
| | - Shaoxing Zhu
- Department of Urology, Zhejiang Provincial Cancer Hospital, Hangzhou, China
| | - Qing Zou
- Department of Urology, Jiangsu Provincial Cancer Hospital, Nanjing, China
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Gandhi J, Seyam O, Smith NL, Joshi G, Vatsia S, Khan SA. Clinical utility of hyperbaric oxygen therapy in genitourinary medicine. Med Gas Res 2018; 8:29-33. [PMID: 29770194 PMCID: PMC5937301 DOI: 10.4103/2045-9912.229601] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Hyperbaric oxygen therapy (HBOT) is a medical technique which delivers oxygen at ambient pressures to increase the amount of dissolved oxygen in the blood and oxygen distribution to tissues. There are several beneficial properties of HBOT concomitant with elevated oxygen distribution in tissue including anti-inflammation, angiogenesis through vascular endothelial growth factor proliferation, augmented fibroblast activity through fibroblast growth factor proliferation, tissue and wound repair, enhancement of lymphocyte and macrophage activity, increased male testosterone secretion, and bactericidal activity. Given its renown in treating conditions such as decompression sickness and carbon monoxide poisoning, HBOT is making gradual strides for use in genitourinary medicine due to its low risk and likeliness to achieve favorable results. Early success has been observed in the treatment of Fournier's gangrene, radiation cystitis, and interstitial cystitis via the elimination of clinical symptoms such as pain. Further indications that have exhibited positive outcomes despite HBOT's ambiguous mechanism of action include cyclophosphamide hemorrhagic cystitis, emphysematous cystitis, pelvic radiation disease, radiation-induced proctopathy, dystrophic calcification of the prostate, erectile dysfunction secondary to urethroplasty, priapism, abnormal renal morphology, blood testosterone, calcific uremic arteriolopathy, and hidradenitis suppurativa. For other indications, multicenter studies must be conducted to determine HBOT's true efficacy, mechanism of action, risks, and advantages over conventional treatments.
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Affiliation(s)
- Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA.,Medical Student Research Institute, St. George's University School of Medicine, Grenada, West Indies
| | - Omar Seyam
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | | | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, NY, USA
| | - Sohrab Vatsia
- Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA.,Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
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3
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Scoping Review and Meta-analysis of Hyperbaric Oxygen Therapy for Radiation-Induced Hemorrhagic Cystitis. Curr Urol Rep 2018; 19:38. [PMID: 29654564 DOI: 10.1007/s11934-018-0790-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW To critically review and summarize existing literature assessing the effectiveness of hyperbaric oxygen therapy (HBOT) for the treatment of radiation-induced urologic injury. RECENT FINDINGS Though 5 of the included 13 studies were published in the last 2-3 years, the only randomized controlled study was performed in 2012. Recent studies have confirmed the safety and efficacy of HBOT as well as identified risk factors for success vs. failure of HBOT for hemorrhagic radiation cystitis (HRC). Of the 602 patients that received HBOT for HRC, 84% had a partial or complete resolution. In the 7 studies that utilized RTOG/EORTC, 75% of patients saw an improvement in hematuria of at least one grade (out of possible 5 total). Of the 499 patients with documented follow-up, 14% experienced recurrence, with a median time to recurrence of 10 months (6 to 16.5 months).
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4
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Dellis A, Papatsoris A, Kalentzos V, Deliveliotis C, Skolarikos A. Hyberbaric oxygen as sole treatment for severe radiation - induced haemorrhagic cystitis. Int Braz J Urol 2017; 43:489-495. [PMID: 28338304 PMCID: PMC5462140 DOI: 10.1590/s1677-5538.ibju.2016.0451] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/01/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To examine the safety and efficacy of hyperbaric oxygen as the primary and sole treatment for severe radiation-induced haemorrhagic cystitis. MATERIALS AND METHODS Hyperbaric oxygen was prospectively applied as primary treatment in 38 patients with severe radiation cystitis. Our primary endpoint was the incidence of complete and partial response to treatment, while the secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. RESULTS All patients completed therapy without complications with a mean follow-up of 29.33 months. Median number of sessions needed was 33. Complete and partial response rate was 86.8% and 13.2%, respectively. All 33 patients with complete response received therapy within 6 months of the haematuria onset. One patient needed cystectomy, while 33 patients were alive at the end of follow-up. CONCLUSIONS Our study suggests the early primary use of hyperbaric oxygen for radiation-induced severe cystitis as an effective and safe treatment option.
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Affiliation(s)
- Athanasios Dellis
- 2nd Department of Surgery, National and Kapodistrian University of Athens, Aretaieion Academic Hospital, Greece
| | - Athanasios Papatsoris
- 2nd Department of Urology, University of Athens, Sismanoglio General Hospital, Athens, Greece
| | - Vasileios Kalentzos
- Department of Diving and Hyperbaric Oxygen, Naval and Veterans Hospital, Athens, Greece
| | | | - Andreas Skolarikos
- 2nd Department of Urology, University of Athens, Sismanoglio General Hospital, Athens, Greece
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Ebiloglu T, Kaya E, Yilmaz S, Özgür G, Kibar Y. Treatment of Resıstant Cyclophosphamide Induced Haemorrhagic Cystıtıs: Revıew of Literature and Three Case Reports. J Clin Diagn Res 2016; 10:PD15-6. [PMID: 27190887 DOI: 10.7860/jcdr/2016/16948.7642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/30/2015] [Indexed: 11/24/2022]
Abstract
Haemorrhagic Cystitis (HC) is defined as diffuse inflammatory bladder bleeding due to many aetiologies. Massive HC often arises from anticancer chemotherapy or radiotherapy for the treatment of pelvic malignancies. Phosphamides are the anti-cancer drugs used for treating breast cancer, B-cell lymphoma, leukemia, rheumatoid arthritis and systemic lupus erythaematosis by cross-linking strands of DNA and preventing the cell division. They are also used in bone marrow transplantation for prevention of Graft Versus Host Disease (GVHD). Hepatic metabolism of phosphamide forms acrolein, and acrolein makes ulceration, haemorrhage, edema and necrosis of the urothelium during its excretion by the urine. Infectious causes of HC in immunocomprimesed patients are adenovirus, BK polyoma-virus (BK), JC virus, and Cytomegalovirus (CMV). The present article attempts to make a review of literature for the treatment of intractable HC and report three cases with HC.
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Affiliation(s)
- Turgay Ebiloglu
- Faculty, Department of Urology, Etimesgut Military Hospital , Ankara, Turkey
| | - Engin Kaya
- Faculty, Department of Urology, Section of Pediatric Urology, Gulhane Military Medical Academy , Ankara, Turkey
| | - Sercan Yilmaz
- Faculty, Department of Urology, Section of Pediatric Urology, Gulhane Military Medical Academy , Ankara, Turkey
| | - Gökhan Özgür
- Faculty, Department of Heamatology, Gulhane Military Medical Academy , Ankara, Turkey
| | - Yusuf Kibar
- Faculty, Department of Urology, Section of Pediatric Urology, Gulhane Military Medical Academy , Ankara, Turkey
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6
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Zwaans BMM, Nicolai HG, Chancellor MB, Lamb LE. Challenges and Opportunities in Radiation-induced Hemorrhagic Cystitis. Rev Urol 2016; 18:57-65. [PMID: 27601964 PMCID: PMC5010626 DOI: 10.3909/riu0700] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
As diagnosis and treatment of cancer is improving, medical and social issues related to cancer survivorship are becoming more prevalent. Hemorrhagic cystitis (HC), a rare but serious disease that may affect patients after pelvic radiation or systemic chemotherapy, has significant unmet medical needs. Although no definitive treatment is currently available, various interventions are employed for HC. Effects of nonsurgical treatments for HC are of modest success and studies aiming to control radiation-induced bladder symptoms are lacking. In this review, we present current and advanced therapeutic strategies for HC to help cancer survivors deal with long-term urologic health issues.
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7
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A Narrative Review on the Pathophysiology and Management for Radiation Cystitis. Adv Urol 2015; 2015:346812. [PMID: 26798335 PMCID: PMC4700173 DOI: 10.1155/2015/346812] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] Open
Abstract
Radiation cystitis is a recognised complication of pelvic radiotherapy. Incidence of radiation cystitis ranges from 23 to 80% and the incidence of severe haematuria ranges from 5 to 8%. High quality data on management strategies for radiation cystitis is sparse. Treatment modalities are subclassified into systemic therapies, intravesical therapies, and hyperbaric oxygen and interventional procedures. Short-term cure rates range from 76 to 95% for hyperbaric oxygen therapy and interventional procedures. Adverse effects of these treatment strategies are acceptable. Ultimately, most patients require multimodal treatment for curative purposes. Large randomised trials exploring emergent management strategies are required in order to strengthen evidence-based treatment strategies. Urologists encounter radiation cystitis commonly and should be familiar with diagnostic modalities and treatment strategies.
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Degener S, Pohle A, Strelow H, Mathers MJ, Zumbé J, Roth S, Brandt AS. Long-term experience of hyperbaric oxygen therapy for refractory radio- or chemotherapy-induced haemorrhagic cystitis. BMC Urol 2015; 15:38. [PMID: 25953493 PMCID: PMC4423090 DOI: 10.1186/s12894-015-0035-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiotherapy and cyclophosphamide-induced haemorrhagic cystitis are rare but severe complications occurring in 3-6% of patients. Hyperbaric oxygen treatment (HBOT) has been demonstrated to be an effective treatment for haematuria not responding to conventional management. Only very few data exist for long-term follow-up after HBOT. METHODS We retrospectively reviewed 15 patients referred for HBOT for haemorrhagic cystitis (HC). HBOT was performed for 130 min/day at a pressure of 2.4 atmospheres. We evaluated patient demographics, type of radio- and chemotherapy and characteristics of haematuria. The effect of HBOT was defined as complete or partial resolution of hematuria according to the RTOG/EORTC grade and Gray score. RESULTS A total of 15 patients (12 after radiotherapy, two after chemotherapy and one patient with a combination of both) were treated with a median of 34 HBO treatments. Radiotherapy patients received primary, adjuvant, salvage and HDR radiotherapy (60 - 78 Gy) for prostate, colon or cervical cancer. The patient with combination therapy and both of the chemotherapy patients were treated with cyclophosphamide. First episodes of haematuria occurred at a median of 48 months after completion of initial therapy. The first HBOT was performed at a median of 11 months after the first episode of hematuria. After a median of a 68-month follow-up after HBOT, 80% experienced a complete resolution and two patients suffered a singular new minor haematuria (p < 0.00001). A salvage-cystectomy was necessary in one patient. No adverse effects were documented. CONCLUSIONS Our experience indicate that HBOT is a safe and effective therapeutic option for treatment-resistant radiogenic and chemotherapy-induced haemorrhagic cystitis. For a better evaluation prospective clinical trials are required.
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Affiliation(s)
- Stephan Degener
- Department of Urology, HELIOS Medical Center Wuppertal, University of Witten/Herdecke, Heusnerstrasse 40, 42283, Wuppertal, Germany.
| | - Alexander Pohle
- Department of Urology, Medical Center Leverkusen, Am Gesundheitspark 11, 51375, Leverkusen, Germany.
| | - Hartmut Strelow
- Institute of Hyperbaric Oxygen (HBO), University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Michael J Mathers
- Urological Ambulatory PandaMED, Alleestrasse 105-107, 42853, Remscheid, Germany.
| | - Jürgen Zumbé
- Department of Urology, Medical Center Leverkusen, Am Gesundheitspark 11, 51375, Leverkusen, Germany.
| | - Stephan Roth
- Department of Urology, HELIOS Medical Center Wuppertal, University of Witten/Herdecke, Heusnerstrasse 40, 42283, Wuppertal, Germany.
| | - Alexander S Brandt
- Department of Urology, HELIOS Medical Center Wuppertal, University of Witten/Herdecke, Heusnerstrasse 40, 42283, Wuppertal, Germany.
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Hoggan BL, Cameron AL. Systematic review of hyperbaric oxygen therapy for the treatment of non-neurological soft tissue radiation-related injuries. Support Care Cancer 2014; 22:1715-26. [PMID: 24794980 DOI: 10.1007/s00520-014-2198-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 03/02/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this paper was to provide an evidence-based evaluation of the safety and effectiveness of hyperbaric oxygen therapy (HBOT) for the treatment of non-neurological soft tissue radiation-related injuries (STRI). METHODS Systematic searches of medical bibliographic databases, the Internet, and lists of references were conducted in December 2010 and April 2013 to identify relevant primary studies. Inclusion and classification of papers was resolved through the application of a predetermined protocol. Information on both the safety and effectiveness of HBOT was analyzed. RESULTS Forty-one articles were included, with 11 comparing HBOT to a regimen without HBOT. Comparative evidence varied considerably in methodological quality, and numerous limitations were identified. Absolute data showed that serious adverse events after HBOT were rare, while more common adverse events were minor and self-limiting. Compared to observation, conventional, or sham therapies, evidence of benefit in clinical outcomes was shown for HBOT for radiation proctitis and wounds in irradiated soft tissue of the head and neck, but not for postirradiation soft tissue edema or radiation cystitis. Clinical outcomes differed little between HBOT and argon plasma coagulation for radiation proctitis and between HBOT and hyaluronic acid for radiation cystitis. CONCLUSIONS HBOT is a safe intervention which may offer clinical benefits to patients suffering from radiation proctitis and non-neurological STRI of the head and neck. However, differing clinical responses across STRI demonstrate a need for further well-designed clinical trials to validate the use of HBOT for individual STRI, both as an adjunct to conventional treatments and relative to definitive treatments.
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Affiliation(s)
- Benjamin L Hoggan
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, 5006, SA, Australia
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10
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Polom W, Klejnotowska A, Matuszewski M, Sicko Z, Markuszewski M, Krajka K. Hyperbaric oxygen therapy (HBOT) in case of hemorrhagic cystitis after radiotherapy. Cent European J Urol 2012; 65:200-3. [PMID: 24578962 PMCID: PMC3921805 DOI: 10.5173/ceju.2012.04.art4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 06/02/2012] [Accepted: 10/08/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We present the effect of hyperbaric oxygen therapy (HBOT) after radiotherapy for cancer in the pelvic cavity resulting in hematuria. Increasing the pressure of oxygen (PO2) in ischemic tissues favors the formation of new blood vessels and increases the secretion of collagen. MATERIAL AND METHODS We evaluated 10 patients who were treated with HBOT from October 2006 to December 2010 due to persistent radiation damage to the lining of the bladder leading to recurrent hematuria. The study group was comprised of seven men and three women. In the case of cervical and endometrial cancers, 30 Gy of brachytherapy with 45-50 Gy of teleradiotherapy were used. In prostate cancer (PCa), we applied 50 Gy of teleradiotherapy with an additional dose of 20-24 Gy, and in the case of bladder cancer (BCa), 50 Gy of teleradiotherapy was applied with an additional dose of 16 Gy. HBOT consisted of 60 HBO2 treatments, in which patients were administered 100% oxygen at a pressure of 2.5 atm. RESULTS The group effect of total or partial resolution was observed in six patients. In one case, treatment was discontinued due to an increase in hematuria and the consequent suspicion of bladder tumor recurrence. While in and additional three cases, the treatment did not produce the desired result. CONCLUSIONS Treatment of hemorrhagic cystitis is a difficult therapeutic challenge. One possible method is the implementation of HBOT. In very difficult cases, HBO2 treatment appears to be effective in giving more than half of patients a chance of getting better.
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Affiliation(s)
- Wojciech Polom
- Department of Urology, Medical University of Gdańsk, Poland
| | - Alicja Klejnotowska
- Department of Hyperbaric Medicine and Sea Rescue - University Center for Maritime and Tropical Medicine in Gdynia, National Center for Hyperbaric Medicine, Gdynia, Poland
| | | | - Zdzislaw Sicko
- Department of Hyperbaric Medicine and Sea Rescue - University Center for Maritime and Tropical Medicine in Gdynia, National Center for Hyperbaric Medicine, Gdynia, Poland
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11
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Degener S, Strelow H, Pohle A, Lazica DA, Windolf J, Zumbé J, Roth S, Brandt AS. [Hyperbaric oxygen in the treatment of hemorrhagic radiogenic cystitis after prostate cancer]. Urologe A 2012; 51:1735-40. [PMID: 23076451 DOI: 10.1007/s00120-012-3036-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postradiation hemorrhagic cystitis is a well known long-term complication of radiation therapy occurring in 3-6 % of patients. Hyperbaric oxygen (HBO) has been demonstrated to be an effective treatment for radiation-induced hemorrhagic cystitis not responding to conventional management. This article reviews experiences with HBO for radiogenic cystitis after prostate cancer. METHODS All patients treated for hemorrhagic cystitis with HBO between 2006 and 2012 were retrospectively reviewed. The HBO procedure was performed for 130 min/day at 1.4 atmospheres overpressure. Patient demographics, type of radiotherapy, onset and severity of hematuria and time between first hemorrhagic episode and beginning of HBO were evaluated. The effect of HBO was defined as complete or partial (lower RTOG/EORTC grade) resolution of hematuria. RESULTS A total of 10 patients with radiogenic cystitis and a median age of 76 years were treated with a median of 30 HBO treatment sessions. Patients received primary, adjuvant, salvage and high dose rate (HDR) radiotherapy (60-78 Gy). First episodes of hematuria occurred after a median of 41 months following completion of radiotherapy and HBO was performed 11 months after the first episode of hematuria. After a median 35-month follow-up 80% experienced complete resolution, one patient suffered a one-off new hematuria and in one patient a salvage cystectomy was necessary. No adverse effects were documented. CONCLUSIONS The experiences indicate that HBO is a safe and effective therapy option in treatment-resistant radiogenic cystitis but prospective clinical trials are needed for a better evaluation.
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Affiliation(s)
- S Degener
- Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Universität Witten/Herdecke, Heusnerstraße 40, 42283 Wuppertal, Deutschland.
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12
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Allen S, Kilian C, Phelps J, Whelan HT. The use of hyperbaric oxygen for treating delayed radiation injuries in gynecologic malignancies: a review of literature and report of radiation injury incidence. Support Care Cancer 2012; 20:2467-72. [PMID: 22246598 DOI: 10.1007/s00520-012-1379-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 01/02/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE The purposes of this paper are to review the best evidence supporting the use of hyperbaric oxygen therapy (HBOT) in delayed radiation injuries in gynecologic malignancies and report the incidence of radiation injuries at two large medical centers in southeastern Wisconsin. METHODS A literature search was performed on Google Scholar, PubMed, and Ovid for studies evaluating the use of HBOT radiation cystitis, proctitis, and necrosis. The studies were then reviewed for the highest quality evidence using American Academy of Neurology guidelines. To evaluate radiation injuries, cancer databases at Froedtert Memorial Lutheran Hospital (FMLH) and Aurora St. Luke's Hospital (ASLH) were accessed. RESULTS Several studies support the use of HBOT in treating radiation cystitis, proctitis, and necrosis, with proctitis having the strongest evidence in its favor. The average annual incidence of radiation injury at FMLH was 13.8%. Patients with cervical cancer and vulvar cancer had rates of 23% each. The average annual incidence of radiation injury among gynecologic cancer patients at ASLH was 5.5%. CONCLUSIONS There is level A evidence for using HBOT to treat radiation proctitis. There is level B evidence for using HBOT to treat radiation cystitis and necrosis. The incidence delayed radiation injuries can be as high as 23%. This has relevance in practice guidelines for the treatment of delayed radiation injuries in gynecologic malignancies.
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Affiliation(s)
- Scott Allen
- Medical College of Wisconsin, Milwaukee, WI 53226, USA
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13
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Craighead P, Shea–Budgell M, Nation J, Esmail R, Evans A, Parliament M, Oliver T, Hagen N. Hyperbaric oxygen therapy for late radiation tissue injury in gynecologic malignancies. Curr Oncol 2011; 18:220-7. [PMID: 21980249 PMCID: PMC3185899 DOI: 10.3747/co.v18i5.767] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Late radiation tissue injury is a serious complication of radiotherapy for patients with gynecologic malignancies. Strategies for managing pain and other clinical features have limited efficacy; however, hyperbaric oxygen therapy (HBO(2)) may be an effective option for some patients. METHODS In a systematic review of the literature, the Ovid medline, embase, Cochrane Library, National Guidelines Clearinghouse, and Canadian Medical Association Infobase databases were searched to June 2009 for clinical practice guidelines, systematic reviews, randomized controlled trials, or other relevant evidence. Studies that did not evaluate soft tissue necrosis, cystitis, proctitis, bone necrosis, and other complications were excluded. RESULTS Two randomized trials, eleven nonrandomized studies, and five supporting documents comprise the evidence base. In addition, information on the harms and safety of treatment with HBO(2) were reported in three additional sources. There is modest direct evidence and emerging indirect evidence that the use of HBO(2) is broadly effective for late radiation tissue injury of the pelvis in women treated for gynecologic malignancies. CONCLUSIONS Based on the evidence and expert consensus opinion, HBO(2) is likely effective for late radiation tissue injury of the pelvis, with demonstrated efficacy specifically for radiation damage to the anus and rectum;the main indication for HBO(2) therapy in gynecologic oncology is in the management of otherwise refractory chronic radiation injury;HBO(2) may provide symptomatic benefit in certain clinical settings (for example, cystitis, soft-tissue necrosis, and osteonecrosis); andHBO(2) may reduce the complications of gynecologic surgery in patients undergoing surgical removal of necrosis.
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Affiliation(s)
- P. Craighead
- Department of Oncology, University of Calgary, Calgary, AB
- Alberta Health Services Cancer Care, Calgary, AB
| | | | - J. Nation
- Department of Oncology, University of Calgary, Calgary, AB
- Alberta Health Services Cancer Care, Calgary, AB
| | - R. Esmail
- Alberta Health Services Cancer Care, Guideline Utilization Resource Unit, Calgary, AB
| | - A.W. Evans
- Hyperbaric Medicine Unit, Toronto General Hospital, and Department of Anesthesia, University of Toronto, Toronto, ON
| | - M. Parliament
- Alberta Health Services Cancer Care, Calgary, AB
- Department of Oncology, and Alberta Health Services Cancer Care, Edmonton, AB
| | - T.K. Oliver
- Capacity Enhancement Program, Canadian Partnership Against Cancer, Hamilton, ON
- Department of Oncology, McMaster University, Hamilton, ON
| | - N.A. Hagen
- Department of Oncology, University of Calgary, Calgary, AB
- Alberta Health Services Cancer Care, Calgary, AB
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14
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Abstract
Acute radiation cystitis occurs during or soon after radiation treatment. It is usually self-limiting, and is generally managed conservatively. Late radiation cystitis, on the other hand, can develop from 6 months to 20 years after radiation therapy. The main presenting symptom is hematuria, which may vary from mild to severe, life-threatening hemorrhage. Initial management includes intravenous fluid replacement, blood transfusion if indicated and transurethral catheterization with bladder washout and irrigation. Oral or parenteral agents that can be used to control hematuria include conjugated estrogens, pentosan polysulfate or WF10. Cystoscopy with laser fulguration or electrocoagulation of bleeding points is sometimes effective. Injection of botulinum toxin A in the bladder wall may relieve irritative bladder symptoms. Intravesical instillation of aluminum, placental extract, prostaglandins or formalin can also be effective. More-aggressive treatment options include selective embolization or ligation of the internal iliac arteries. Surgical options include urinary diversion by percutaneous nephrostomy or intestinal conduit, with or without cystectomy. Hyperbaric oxygen therapy (HBOT) involves the administration of 100% oxygen at higher than atmospheric pressure. The reported success rate of HBOT for radiation cystitis varies from 60% to 92%. An important multicenter, double-blind, randomized, sham-controlled trial to evaluate the effectiveness of HBOT for refractory radiation cystitis is currently being conducted.
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Affiliation(s)
- Shaun G Smit
- Department of Urology, University of Stellenbosch and Tygerberg Hospital, PO Box 19063, Tygerberg 7505, South Africa.
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Srinivas S. Acute Toxicities of Therapy: Urologic Complications. Oncology 2007. [DOI: 10.1007/0-387-31056-8_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wines MP, Lynch WD. A new minimally invasive technique for treating radiation cystitis: the argon-beam coagulator. BJU Int 2006; 98:610-2. [PMID: 16925761 DOI: 10.1111/j.1464-410x.2006.06293.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the effectiveness of the argon-beam coagulator used endoscopically for treating radiation cystitis, as radiotherapy is commonly used for treating pelvic tumours of urological origin, but intractable bleeding related to radiation cystitis remains a serious complication and requires a difficult long-term follow-up, for which cystoscopic methods of management have traditionally had limited success. PATIENTS AND METHODS We assessed seven patients with radiation cystitis; they were treated with argon-beam coagulation after a cystoscopic evaluation. RESULTS With a mean follow-up of 15 months, one treatment was used in six patients, with a second treatment required in one. CONCLUSION The argon-beam coagulator appears to be a safe, well tolerated and minimally invasive treatment in patients with radiation cystitis.
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Affiliation(s)
- Michael P Wines
- Department of Urology, St George Public Hospital, Kogarah, NSW, Australia.
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Clavo B, Gutiérrez D, Martín D, Suárez G, Hernández MA, Robaina F. Intravesical ozone therapy for progressive radiation-induced hematuria. J Altern Complement Med 2005; 11:539-41. [PMID: 15992242 DOI: 10.1089/acm.2005.11.539] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Progressive radiation-induced cystitis can become a serious clinical problem the therapeutic solution of which is limited and almost invariably aggressive. Ozone therapy is a nonconventional therapy that has been reported to offer benefits in late-onset wound healing and ischemic disorders. This report describes a patient with progressive radiation-induced hematuria from standard conservative treatment that was further treated with ozone therapy. METHOD Ozone therapy was achieved by intravesical instillation of ozonized bi-distilled water over a period of 30 minutes, three sessions per week during the first weeks. Later, ozone therapy sessions were decreased and involved ozonized water or direct intravesicular instillation of ozone at 20-25 microg/mL. RESULTS Hematuria was successfully controlled by intravesical application of ozone therapy. CONCLUSIONS The successes achieved with this technique suggest that intravesicular instillation of ozonized bi-distilled water or ozone merits further investigation with a view to its application to counter this radiation-induced side-effect.
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Affiliation(s)
- Bernardino Clavo
- Department of Radiation Oncology, Research Unit, Dr. Negrin University Hospital, Las Palmas, Spain.
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Neheman A, Nativ O, Moskovitz B, Melamed Y, Stein A. Hyperbaric oxygen therapy for radiation-induced haemorrhagic cystitis. BJU Int 2005; 96:107-9. [PMID: 15963131 DOI: 10.1111/j.1464-410x.2005.05577.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the efficacy of hyperbaric oxygen (HBO) for treating haemorrhagic cystitis. PATIENTS AND METHODS From February 1997 to April 2004, seven patients with radiation-induced haemorrhagic cystitis were treated with HBO; they received a mean (range) of 30 (18-57) HBO treatments and the follow-up was 24 (3-53) months. RESULTS The haematuria resolved completely in all seven patients shortly after treatment; one had an improvement but died from complications relating to cancer shortly after completing treatment, and two had recurrence of gross haematuria. They were re-treated with HBO until the haematuria resolved. CONCLUSIONS Radiation-induced haemorrhagic cystitis can be treated successfully with HBO primarily or after failure of standard regimens. This method was well tolerated even in patients debilitated by advanced cancer and blood loss. Long-term remission is possible in most patients, and re-treatment effectively manages recurrent bleeding.
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Affiliation(s)
- Amos Neheman
- Department of Urology, Carmel Hospital, Haifa, Israel.
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Denton AS, Clarke NW, Maher EJ. Non-surgical interventions for late radiation cystitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev 2002; 2002:CD001773. [PMID: 12137633 PMCID: PMC7025765 DOI: 10.1002/14651858.cd001773] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic radiation cystitis occurs a minimum of three months after completion of pelvic radiotherapy and represents a range of clinical symptoms for which there is as yet no recommended standard management. OBJECTIVES The aim of this review was to identify the various non-surgical treatment options for the management of late chronic radiation cystitis and evaluate the evidence. SEARCH STRATEGY Synonyms for radiation therapy and for the spectrum of radiation toxicity to the bladder in both text and MeSH terms were combined and applied to a range of databases without restriction of year of publication, methodology or language. SELECTION CRITERIA The inclusion criteria included studies of interventions for the non-surgical management of all grades of late radiation cystitis. DATA COLLECTION AND ANALYSIS Out of 80 relevant studies, there were no RCTs that met the inclusion criteria, but there were three prospective case series and two non-randomised studies which assessed different interventions and were not comparable. MAIN RESULTS Sixty-three reports met the stated inclusion criteria. The majority were predominantly retrospective case series with the exception of two trials which were unrandomised and unblinded studies with a control group for comparison of effect. Although these two trials, Micic 1988, (intravesical placental extract) and Milani 1988, (flavoxate) provided the strongest evidence they were not randomised and were essentially isolated controlled studies. REVIEWER'S CONCLUSIONS In such a relatively rare condition there are obvious difficulties in identifying sufficient patients to participate in a randomised controlled trial. The number of published reports is a reflection of the degree of medical interest that exists in providing therapeutic solutions for late radiation cystitis. However, in spite of the two studies of level IIA evidence, the absence of randomised controlled trials makes it impossible to draw any firm conclusions.
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Affiliation(s)
- A S Denton
- Centre for Cancer Treatment, Mount Vernon Hospital, Rickmansworth Rd, Northwood, Middlesex, UK, HA6 2RN.
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