Radiation-induced Hemorrhagic Cystitis Research Articles

Is there a role for hyberbaric oxygen as primary treatment for grade IV radiation-induced haemorrhagic cystitis? A prospective pilot-feasibility study and review of literature.

To examine the safety and efficacy of hyperbaric oxygen as the primary treatment for Grade IV radiation-induced haemorrhagic cystitis. Hyperbaric oxygen was prospectively applied as a primary treatment option in 11 patients with Grade IV radiation cystitis. Primary endpoint was the incidence of complete and partial response to treatment. 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. All patients completed therapy without complications for a mean follow-up of 17.82 months (range 3 to 34). Mean number of sessions needed was 32.8 (range 27 to 44). Complete and partial response rate was 81.8% and 18.2%, respectively. However, in three patients the first treatment session was not either sufficient or durable giving a 72.7% rate of durable effect. Interestingly, all 9 patients with complete response received therapy within 6 months of the haematuria onset compared to the two patients with partial response who received therapy at 8 and 10 months from the haematuria onset, respectively (p = 0.018). The need for blood transfusion (p = 0.491) and the total radiation dose (p = 0.259) were not correlated to success-rate. One patient needed cystectomy, while all patients were alive at the end of follow-up. Early primary use of hyperbaric oxygen to treat radiation-induced grade IV cystitis is an effective and safe treatment option.

473 Hyperbaric oxygen therapy for radiation-induced hemorrhagic cystitis

473 Hyperbaric oxygen therapy for radiation-induced hemorrhagic cystitis

Transurethral Coagulation for Radiation-Induced Hemorrhagic Cystitis Using Greenlight™ Potassium-Titanyl-Phosphate Laser

The aim of this study was to to demonstrate the initial treatment outcomes of Greenlight™ potassium-titanyl-phosphate (KTP) laser on radiation-induced hemorrhagic cystitis. Hemorrhagic cystitis is a common complication of radiation therapy for pelvic tumors. From September 2004 to February 2011, 10 patients with radiation-induced intractable hemorrhagic cystitis underwent transurethral Greenlight KTP laser coagulation of the bladder. The power setting was limited to 20-30 W. Bleeding stopped in all cases after one session of laser treatment. Mean follow-up time was 17 months (6-36 months). All patients underwent cystoscopy 3 months postoperatively, and no bleeding or significant scar was found. Recurrence of significant bleeding was seen in one case 7 months post-operation, and was again cured by KTP laser. There were no complications from the procedures. Our experience suggests that transurethral coagulation using KTP laser is a safe and effective strategy for the treatment of hemorrhagic radiation cystitis.

Hyperbare Sauerstofftherapie bei hämorrhagischer Strahlenzystitis nach Prostatakarzinom

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. 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. 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. 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.

Hyperbaric Oxygen Therapy for Radiation-Induced Cystitis and Proctitis

To provide a retrospective analysis of the efficacy of hyperbaric oxygen therapy (HBOT) for treating hemorrhagic cystitis (HC) and proctitis secondary to pelvic- and prostate-only radiotherapy. Nineteen patients were treated with HBOT for radiation-induced HC and proctitis. The median age at treatment was 66 years (range, 15-84 years). The range of external-beam radiation delivered was 50.0-75.6 Gy. Bleeding must have been refractory to other therapies. Patients received 100% oxygen at 2.0 atmospheres absolute pressure for 90-120 min per treatment in a monoplace chamber. Symptoms were retrospectively scored according to the Late Effects of Normal Tissues-Subjective, Objective, Management, Analytic (LENT-SOMA) scale to evaluate short-term efficacy. Recurrence of hematuria/hematochezia was used to assess long-term efficacy. 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 follow-up was 39 months (range, 7-70 months). No cases of hematuria were refractory to HBOT. Complete resolution of hematuria was seen in 81% (n = 9) and partial response in 18% (n = 2). Recurrence of hematuria occurred in 36% (n = 4) after a median of 10 months. Complete resolution of hematochezia was seen in 50% (n = 2), partial response in 25% (n=1), and refractory bleeding in 25% (n= 1). Hyperbaric oxygen therapy is appropriate for radiation-induced HC once less time-consuming therapies have failed to resolve the bleeding. In these conditions, HBOT is efficacious in the short and long term, with minimal side effects.

Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation‐induced hemorrhagic cystitis

• To compare the efficacy of intravesical hyaluronic acid (HA) instillation and hyperbaric oxygen (HBO) in the treatment of radiation-induced haemorrhagic cystitis (HC). • In total 36 patients who underwent radiotherapy for their pelvic malignancies and subsequently suffered from HC were randomly divided into an HA group and an HBO group. • Symptoms of haematuria, frequency of voiding and the visual analogue scale of pelvic pain (range 0-10) were evaluated before and after the treatment with follow-up of 18 months. • All patients completed this study and no obvious side effects of intravesical HA were recorded. • The improvement rate showed no statistical difference between the two groups at 6, 12 and 18 months after treatment. • Decrease of frequency was significant in both groups 6 months after treatment, but was only significant in the HA group 12 months after therapy. • The improvement in the visual analogue scale remained significant in both groups for 18 months. • Intravesical instillation of HA was as effective in treating radiation-induced HC as HBO. • It is well tolerated and resulted in a sustained decrease of bladder bleeding, pelvic pain and frequency of voiding for at least 12 months.

放射線性出血性膀胱炎にプレドニゾロンが有効であった1例

Hemorrhagic cystitis resulting from radiation to pelvic visceral malignant lesions often might be incurable and there have been no established definitive treatment. We experienced a case with severe radiation-induced hemorrhagic cystitis refractory to conventional therapy. The treatment with oral administration of prednisolone was performed and obtained a successful result. Gross hematuria disappeared in 2 weeks in this case. This experience suggested that oral administration of prednisolone could be considered the treatment for patients with radiation-induced hemorrhagic cystitis when usual treatments including transurethral electro-coagulation are unsuccessful.

The Use of Hyperbaric Oxygen Therapy in Radiation-Induced Haemorrhagic Cystitis

Haemorrhagic cystitis is a diffuse inflammatory condition of the bladder leading to bleeding from the bladder mucosa. Severe haemorrhagic cystitis can be caused by radiotherapy, chemotherapy or infection. We report the case of a 58 year old male, who developed haemorrhagic cystitis secondary to previous salvage radiotherapy for prostate cancer. After failing all conservative measures including bladder irrigation, tranexamic acid, and cystoscopic cauterisation, he underwent 48 sessions of hyperbaric oxygen therapy. This proved efficacious in managing this difficult condition. At 3 month follow up post final hyperbaric treatment, he has had no further episodes of bleeding. Further, we provide a review of current treatment options for hemorrhagic cystitis.

Hyperbaric Oxygen-therapy for Radiation-induced Hemorrhagic Cystitis

Hyperbaric Oxygen-therapy for Radiation-induced Hemorrhagic Cystitis

Effects of hyperbaric oxygen therapy on in vivo marine prostate cancer cell PC-3

Objective To assess the effects of hyperbaric oxygen(HBO) on indolent prostate cancer on a murine model. Methods Human prostate cancer cell line PC-3 ceils were injected into 40 severe combined-immunodeficient mice. They were randomized to undergo 20 sessions of either HBO or normobarie air in standardized conditions, and observed for 4 weeks before the histological assess-ment of any palpable tumors developed. The analysis parameters included tumour volume, microvessel density, apoptosis markers (p53, p27) and proliferative index (Ki-67). Results On the 28th day af-ter tumor vaccination, the tumor volume was (425.8±13.9)mm3 in HBO group and (433.6±12.8) mm3 in normobaric air group (P>0.05). Mierovessel density and Ki-67, p53, p27 protein expression were 69.7±9.5, (55. 2±6. 7)%, (31.9±5. 3)%, (80. 4±5. 7)% in HBO group;77. 1±8. 7, (50.6±7.3)%, (30.5±4. 7)%, (85.3±6.4)% in norrnobaric air group, respectively. There were no significant differences in both groups (P>0. 05). Conclusions HBO does not accelerate the growth of indolent prostate cancer in murine model. This result suggests that HBO does not increase the risk of residual prostate cancer reactivation when it is used to manage radiation-induced hemorrhag-ic cystitis in patients treated by pelvic radiotherapy for prostate cancer. Key words: Hyperbaric oxygenation; Prostatic neoplasms; Radiotherapy; Hemorrhagiccystitis

Laparoscopic Cystoprostatectomy for Radiation-Induced Hemorrhagic Cystitis

Hemorrhagic cystitis after radiotherapy is a relatively rare event, usually occurring several years after radiation treatment. It can be relentlessly progressive, and treatment options are usually suboptimal. No management strategy is fully successful, and a stepwise progression in treatment intensity is often necessary with cystectomy and urinary diversion being the final management option. Laparoscopic cystoprostatectomy with minilaparotomy ileal conduit urinary diversion was successfully performed in three patients with severe refractory hemorrhagic cystitis secondary to radiation treatment for prostate cancer. More conservative management had failed in all three patients with continued severe and life-threatening bleeding. No intraoperative complications were encountered in spite of the obliteration of tissue planes after radiation treatment. Mean operative time was 4 hours and 45 minutes, including the urinary diversion. Blood loss ranged from 50 to 200 mL. Postoperative recovery was uneventful with the exception of prolonged ileus in one patient, which resolved conservatively. Radiation treatment for prostate cancer is not an absolute contraindication for laparoscopic cystoprostatectomy, which can still be safely performed in some of these patients. Extension of this experience to patients with malignant disease remains to be evaluated.

Hyperbaric oxygen therapy for radiation‐induced hemorrhagic cystitis

Hyperbaric oxygen (HBO) therapy has recently emerged as a potential primary option for the management of hemorrhagic cystitis. We review our experience treating hemorrhagic cystitis with HBO. Between January 2001 and May 2007, eight patients with radiation-induced hemorrhagic cystitis underwent HBO therapy. There were five men and three women with a mean age of 64.3 years (47-73). Radiation was given for local disease, and the mean dosage delivered was 56.6 Gy (42-70). The mean duration between the onset of hematuria and the beginning of HBO therapy was 8.9 months (3-34). Mean follow-up period was 15.5 months (2-31). Hematuria resolved completely in six of the eight patients, one of whom suffered recurrence of hematuria and was treated with HBO until the hematuria resolved again. The response rate was 75%, compatible with the previous reports, and no side-effects of HBO were noted. HBO treatment should be attempted for radiation-induced hemorrhagic cystitis.

Metastatic Hepatocellular Carcinoma in the Urinary Bladder with Radiation-induced Hemorrhagic Cystitis

Metastatic hepatocellular carcinoma (HCC) to the urinary bladder is very rare. We present the case of a 58-year-old female patient who was diagnosed to have both HCC and cervical cancer. She developed hemorrhagic cystitis 2 years after radiation therapy for cervical cancer. During endoscopic electrocauterization for hemorrhagic cystitis, three small reddish tumors measuring less than 1 cm in diameter and with a raspberry-like appearance were found. Transurethral bladder tumor resection was performed. Pathology confirmed metastatic HCC to the bladder. Due to the similar appearance, these tumors are liable to be misinterpreted as engorged vessels secondary to irradiation if biopsies are not taken. Differential diagnosis by pathology is mandatory for such patients.

Treatment of voiding dysfunction following radiation therapy for carcinoma of the prostate

Radiation therapy for the treatment of prostate cancer has made tremendous advances in the past century but is still associated with significant urinary morbidities. These complications are divided into acute and late toxicities. Among the recognized acute toxicities are dysuria and urinary retention. Management differs from late toxicities, which may include urethral strictures, fistulas, and radiation-induced hemorrhagic cystitis. Although identical problems are seen in the absence of radiation, the management of these complications is altered by the additive effect of radiotherapy. This is likely due to progressive obliterative endarteritis triggered by radiation therapy. On the basis of the evolving tissue effects of radiotherapy, each treatment should be individualized and tailored to the patient, form and dosage of radiation, and the tissue quality.

Early Hyperbaric Oxygen Therapy Improves Outcome for Radiation-Induced Hemorrhagic Cystitis

Early Hyperbaric Oxygen Therapy Improves Outcome for Radiation-Induced Hemorrhagic Cystitis

Hyperbaric oxygen therapy for radiation‐induced haemorrhagic cystitis

To assess the efficacy of hyperbaric oxygen (HBO) for treating haemorrhagic cystitis. 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. 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. 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.

Early hyperbaric oxygen therapy improves outcome for radiation-induced hemorrhagic cystitis

Objectives To assess the clinical factors that affect the efficacy of hyperbaric oxygen (HBO 2) therapy in treating radiation-induced hemorrhagic cystitis. HBO 2 therapy is an effective treatment for radiation-induced hemorrhagic cystitis, with reported response rates ranging from 76% to 100%. Methods The data from patients with radiation-induced hemorrhagic cystitis treated at our institution between May 1988 and December 2001 were reviewed retrospectively. All patients received HBO 2 therapy at 2.36 atm absolute pressure, with 90 minutes of 100% oxygen breathing per treatment. The outcome was assessed after at least 12 months of follow-up. We evaluated patient demographics, types of pelvic malignancy and radiotherapy, total radiation dose, onset and severity of hematuria, and prior intravesical management. Clinical improvement was defined as the absence of, or reduction in, macroscopic hematuria. Results A total of 60 patients (55 men and 5 women), mean age 70 years, received an average of 33 HBO 2 treatments (range 9 to 63). Of the 60 patients, 48 (80%) had either total or partial resolution of hematuria. When treated within 6 months of hematuria onset, 96% (27 of 28) had complete or partial symptomatic resolution ( P = 0.003). All 11 patients with previous clot retention had clinical improvement if treated within 6 months of hematuria onset ( P = 0.007). Prior intravesical chemical instillation did not affect the clinical outcome. Patients who had undergone primary, adjuvant, or salvage external beam pelvic radiotherapy showed response rates of 81%, 83%, and 78%, respectively ( P = 0.950). Conclusions Our results show that delivery of HBO 2 therapy within 6 months of hematuria onset is associated with a greater therapeutic response rate. Treatment efficacy was independent of prior intravesical therapy and the timing of radiotherapy.

65: Early Hyperbaric Oxygen Therapy Improves Outcome for Radiation-Induced Hemorrhagic Cystitis

65: Early Hyperbaric Oxygen Therapy Improves Outcome for Radiation-Induced Hemorrhagic Cystitis

Hyperbaric oxygen does not accelerate latent in vivo prostate cancer: implications for the treatment of radiation‐induced haemorrhagic cystitis

To assess the effects of hyperbaric oxygen (HBO2; often used to treat haemorrhagic cystitis, a known side-effect after radiation therapy for prostate cancer and with the potential to induce tumour angiogenesis and stimulate latent recurrence) on indolent in vivo prostate cancer in a murine model. Human prostate LNCaP cells were injected into 60 severe combined-immunodeficient mice; of these 24 (40%) did not develop palpable tumours after 6 weeks. They were randomized to undergo 20 sessions of either HBO2 or normobaric air in standardized conditions, and observed for another 4 weeks before the histological assessment of any palpable tumours that developed. Analysis of developed LNCaP tumours included tumour volume, microvessel density, MIB-1, p53, p27 and racemase staining intensity. HBO2 was associated with less prostate tumour progression than normobaric air (P = 0.26). During HBO2 therapy, 10 mice remained free of palpable tumours, compared with seven controls (P = 0.30). On evaluation during the 4 weeks after therapy, six mice treated with HBO2 remained free of palpable tumours, vs eight of the controls (P = 0.17). There was tumour invasion and necrosis in a two of six and four of the HBO2 group during and after therapy, respectively, vs five and seven of the controls. Tumour microvessel density, proliferative index, differentiation and apoptosis markers were similar in both groups. HBO2 does not accelerate the growth of indolent prostate cancer in a murine model, suggesting that it does not increase the risk of residual prostate cancer reactivation when it is used to manage radiation-induced haemorrhagic cystitis in patients treated by pelvic radiotherapy for prostate cancer.

Hyperbaric Oxygen for the Treatment of Interstitial Cystitis: Long-Term Results of a Prospective Pilot Study

No AccessJournal of UrologyUrological Survey: Abstracts: Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology1 Dec 2004Hyperbaric Oxygen for the Treatment of Interstitial Cystitis: Long-Term Results of a Prospective Pilot Study Alan J. WeinM.D. Alan J. WeinAlan J. Wein More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)61465-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Hyperbaric Oxygen for the Treatment of Interstitial Cystitis: Long-Term Results of a Prospective Pilot Study." The Journal of Urology, 172(6 Part 1), p. 2496 References 1 : Primary treatment of radiation-induced hemorrhagic cystitis with hyperbaric oxygen: 10-year experience. J Urol1994; 151: 1514. Link, Google Scholar © 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 172Issue 6 Part 1December 2004Page: 2496 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.MetricsAuthor Information Alan J. Wein More articles by this author Expand All Advertisement PDF downloadLoading ...