Radiation Proctitis/Cystitis

Occasionally radiation treatment of pelvic cancers can cause damage to the bowel and bladder wall.  Soft tissue radiation damage of the large bowel or bladder can be effectively treated with hyperbaric oxygen.

Radiation cystitis

Radiation cystitis is a recognized complication of radiation therapy for pelvic cancers.

It can be either  acute or chronic. Radiation cystitis typically occurs  within 3 months of starting treatment and normally resolves on completion of radiotherapy.  Symptoms including painful urination, urinary frequency, urge incontinence and blood in the urine (with or without blood clot occlusion causing urinary retention).

Although symptoms of chronic radiation cystitis can begin early they may not become apparent until months to years later after radiation therapy (median 8–12 months after the completion of therapy).  Symptoms of chronic radiation cystitis may include those of acute radiation cystitis but may also include severe bleeding and blood clots, fistula and urinary obstruction.

The incidence of chronic radiation cystitis is estimated at 2%–20%

Radiation cystitis should be suspected in any patient who has had pelvic radiation exposure and presents with the symptoms mentioned above.

Hyperbaric oxygen therapy (HBOT) is a recognized treatment option for radiation cystitis.

The most recent meta-analysis compiled by the Undersea and Hyperbaric Medical Society in 2014 for the 13th edition of their hyperbaric oxygen therapy indications, pooled data for 257 cases of radiation cystitis. HBOT treatments ranged from 2.0 ATA to 2.5 ATA, for 30-40 treatments. 196 (76.3%) experienced improvement of symptoms.

We receive patients referrals from specialists and General Practitioners.  Treatment for radiation cystitis typically involves 40-60 treatments with hyperbaric oxygen therapy at 2.4ATA.  This attracts a Medicare rebate and is supported by all private health funds, meaning all people we treat face little to no out of pocket expense, other than admission co-pays they had negotiated with their fund on joining.

References:

Feldmeier JJ. Delayed Radiation Injuries (Soft tissue and bony necrosis). Undersea and Hyperbaric Medical Society Hyperbaric Oxygen Therapy Indications Edition 13, Chapter 8 113-138. 2014, Best Publishing Company. North Palm Beach, Florida.

Radiation proctitis

Radiation proctitis is a recognized complication of radiation therapy for pelvic cancers.

It can be either acute or chronic. Acute radiation proctitis typically occurs within 3 months of starting treatment and are normally resolves on completion of radiotherapy.  Symptoms include diarrhoea, nausea, cramps, urgency, mucus discharge and minor bleeding.

Although symptoms of chronic radiation proctitis can begin early symptoms may not become apparent until months to years later after the cessation of therapy (median 8–12 months after the completion of therapy). Symptoms of chronic proctitis may include those of acute radiation proctitis but may further include severe bleeding, strictures, perforation, fistula, and bowel obstruction.

The incidence of chronic radiation proctitis is estimated at 2%–20%

Radiation proctitis should be suspected in any patient who has had pelvic radiation exposure and presents with the symptoms mentioned above. The majority are diagnosed after colonoscopy or sigmoidoscopy.

Fistulising disease including rectovaginal, rectourethral, and rectovesicular fistulas may be late presenting symptoms of radiation proctitis but usually will be preceded by other symptoms.

HBOT is recognized treatment option for radiation proctitis.

The most recent meta-analysis compiled by the Undersea and Hyperbaric Medical Society in 2014 for the 13th edition of their hyperbaric oxygen therapy indications, pooled data for 199 cases of radiation proctitis, colitis and enteritis. HBOT treatments ranged from 2.0 ATA to 2.5 ATA, for 30-40 treatments. 80 (41%) of the subjects experienced complete resolution of all symptoms, 169 (86%) experienced improvement of symptoms, leaving 14% who experienced no benefit from undergoing HBOT.

We receive patients referrals from specialists and General Practitioners.  Treatment for radiation proctitis typically involves 40-60 treatments with hyperbaric oxygen therapy at 2.4ATA.  This attracts a Medicare rebate and is supported by all private health funds, meaning all people we treat face little to no out of pocket expense, other than admission co-pays they had negotiated with their fund on joining.

References:

Nhue L. Do, Deborah Nagle, and Vitaliy Y. Poylin. Radiation Proctitis: Current Strategies in Management. Gastroenterology Research and Practice, Volume 2011 (2011) http://dx.doi.org/10.1155/2011/917941

Feldmeier JJ. Delayed Radiation Injuries (Soft tissue and bony necrosis). Undersea and Hyperbaric Medical Society Hyperbaric Oxygen Therapy Indications Edition 13, Chapter 8 113-138. 2014, Best Publishing Company. North Palm Beach, Florida.

Clarke RE, Tenorio LMC, Hussey JR, et al. Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a randomised and controlled double blind crossover trial with long term follow up. Int J Radiat Oncol Biol Phys. 2008;72(1):134-143.