Long-term experience of hyperbaric oxygen therapy for refractory radio- or chemotherapy-induced haemorrhagic cystitis

• Published in: BMC urology Vol. 15; no. 1; p. 38
• Main Authors: Degener, Stephan, Pohle, Alexander, Strelow, Hartmut, Mathers, Michael J, Zumbé, Jürgen, Roth, Stephan, Brandt, Alexander S
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.05.2015; BioMed Central
• Subjects: Adult; Age Factors; Aged; Chemoradiotherapy - adverse effects; Cohort Studies; Cyclophosphamide - adverse effects; Cyclophosphamide - therapeutic use; Cystitis - etiology; Cystitis - physiopathology; Cystitis - therapy; Female; Follow-Up Studies; Hematuria - etiology; Hematuria - physiopathology; Hematuria - therapy; Humans; Hyperbaric Oxygenation - methods; Male; Middle Aged; Quality of Life; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Factors; Time Factors; Treatment Outcome
• ISSN: 1471-2490; 1471-2490
• DOI: 10.1186/s12894-015-0035-4

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. 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. 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. 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.