Hyperbaric oxygen therapy for chronic bowel dysfunction after pelvic radiotherapy

Abstract

The recent publication in The Lancet Oncology by Mark Glover and colleagues 1 Glover M Smerdon GR Andreyev HJ et al. Hyperbaric oxygen for patients with chronic bowel dysfunction after pelvic radiotherapy (HOT2): a randomised, double-blind, sham-controlled phase 3 trial. Lancet Oncol. 2016; 17: 224-233 Summary Full Text Full Text PDF PubMed Scopus (46) Google Scholar of a randomised controlled trial comparing standard hyperbaric oxygen therapy at 2·4 atmospheres of absolute pressure (ATA) and sham treatment (breathing air at 1·3 ATA) in patients with chronic gastrointestinal symptoms following pelvic radiotherapy is a detailed brave attempt at shedding light on a vexed area of clinical practice. Moreover, this monumental effort at improving the evidence base for continuing care in this heterogenous cohort of pelvic cancer survivors, is above all else a tribute to the motivation, forebearance, and goodwill of these patients. It is also a tribute to the high standard of care that the patients received during initial cancer treatment, and during follow-up care at the Royal Marsden Hospital, by a number of expert clinicians over many years. The coordinated participation of ten hyperbaric treatment centres in the implementation of this trial, and their care for trial patients during 40 pressure exposures, is also a significant achievement. Hyperbaric oxygen for patients with chronic bowel dysfunction after pelvic radiotherapy (HOT2): a randomised, double-blind, sham-controlled phase 3 trialWe found no evidence that patients with radiation-induced chronic gastrointestinal symptoms, including those patients with rectal bleeding, benefit from hyperbaric oxygen therapy. These findings contrast with evidence used to justify current practices, and more level 1 evidence is urgently needed. Full-Text PDF Open AccessHyperbaric oxygen therapy for chronic bowel dysfunction after pelvic radiotherapy – Authors' replyWe appreciate the correspondence, and concede that there is a risk of cognitive bias in defending our own results, but would some of the points have been raised if we had generated evidence of efficacy? Whatever the answer, “vast experience” and a single positive randomised study (HORTIS) do not justify a conclusion that HOT2 generated a false negative result, especially in light of evidence emphasising the poor reproducibility of clinical studies.1,2 On another important point, the patients were not mildly affected. Full-Text PDF