International Journal of Radiation Oncology * Biology * Physics
Volume 72, Issue 1 , Pages 134-143.e15 , 1 September 2008

Hyperbaric Oxygen Treatment of Chronic Refractory Radiation Proctitis: A Randomized and Controlled Double-Blind Crossover Trial With Long-Term Follow-Up

  • Richard E. Clarke, C.H.T.

      Affiliations

    • Baromedical Research Foundation, Columbia, SC
    • Corresponding Author InformationReprint requests to: Richard E. Clarke, C.H.T., 5 Richland Medical Park, Columbia, SC 29203. Tel: (803) 434-7101; Fax: (803) 434-4354
  • ,
  • L. M. Catalina Tenorio, M.D.

      Affiliations

    • Department of Radiation Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico
  • ,
  • James R. Hussey, Ph.D.

      Affiliations

    • Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC
  • ,
  • Akin S. Toklu, M.D.

      Affiliations

    • Department of Underwater and Hyperbaric Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
  • ,
  • D. Lindsie Cone, M.D.

      Affiliations

    • Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC
  • ,
  • Jose G. Hinojosa, M.D.

      Affiliations

    • Department of Radiation Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico
  • ,
  • Samir P. Desai, B.D.S., M.H.A.

      Affiliations

    • Baromedical Research Foundation, Columbia, SC
  • ,
  • Luis Dominguez Parra, M.D.

      Affiliations

    • Department of Surgery, Instituto Nacional de Cancerologia, Mexico City, Mexico
  • ,
  • Sylvia D. Rodrigues, M.D.

      Affiliations

    • Department of Radiation Oncology, University of Pretoria Medical Centre, Pretoria, Republic of South Africa
  • ,
  • Robert J. Long, M.D.

      Affiliations

    • Wesley Centre for Hyperbaric Medicine, Wesley Medical Centre, Brisbane, Australia
  • ,
  • Margaret B. Walker, M.D.

      Affiliations

    • Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Tasmania, Australia

Received 19 October 2007 ,Revised 7 December 2007 ,Accepted 12 December 2007.

References 

  1. Duenas-Gonzalez A, Cetina L, Mariscal I, et al. Modern management of locally advanced cervical carcinoma. Cancer Treat Rev. 2003;29:389–399
  2. O'Brien PC. Radiation injury of the rectum. Radiother Oncol. 2001;60:1–4
  3. Johnston MJ, Robertson GM, Frizelle FA. Management of late complications of pelvic radiation in the rectum and anus. Dis Colon Rectum. 2003;46:247–259
  4. O'Brien PC, Hamilton CS, Denham JW, et al. Spontaneous improvement in late rectal mucosal changes after radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2004;58:75–80
  5. Chun M, Kang S, Kil HJ, et al. Rectal bleeding and its management after irradiation for uterine cervical cancer. Int J Radiat Oncol Biol Phys. 2004;58:98–105
  6. Wang CJ, Leung SW, Chen HC, et al. The correlation of acute toxicity and late rectal injury in radiotherapy for cervical carcinoma: Evidence suggestive of consequential late effect (CQLE). Int J Radiat Oncol Biol Phys. 1998;40:85–91
  7. Hamberger AD, Unal A, Gershenson DM, et al. Analysis of the severe complications of irradiation of carcinoma of the cervix: Whole pelvis irradiation and intracavitary radium. Int J Radiat Oncol Biol Phys. 1983;9:367–371
  8. Gilinsky NH, Burns DG, Barbezat GO, et al. The natural history of radiation-induced proctosigmoiditis: An analysis of 88 patients. Q J Med New Series LII. 1983;205:40–53
  9. Fischer L, Kimose HH, Spjeldnaes N, et al. Late progress of radiation-induced proctitis. Acta Chir Scand. 1990;156:801–805
  10. Dent OF, Galt E, Chapuis PH, et al. Quality of life in patients undergoing treatment for chronic radiation-induced rectal bleeding. Br J Surg. 1998;85:1251–1254
  11. Gammi B, Harrington K, Blake P, et al. How patients manage gastrointestinal symptoms after pelvic radiotherapy. Aliment Pharmacol Ther. 2003;18:987–994
  12. Allen-Mersh TG, Wilson EJ, Hope-Stone HF, et al. The management of late radiation-induced rectal injury after treatment of carcinoma of the uterus. Surg Gynecol Obstet. 1987;164:521–524
  13. Andreyev J. Gastrointestinal complications of pelvic radiotherapy: Are they of any importance?. Gut. 2005;54:1051–1054
  14. Eifel PJ, Levenback C, Wharton JT, et al. Time course and incidence of late complications in patients treated with radiation therapy for FIGO stage IB carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys. 1995;32:1289–1300
  15. Denton AS, Andreyev HJN, Forbes A, et al. Systematic review for non-surgical interventions for the management of late radiation proctitis. Br J Cancer. 2002;87:134–143
  16. Feldmeier JJ, Hampson NB. A systematic review of the literature reporting the application of hyperbaric oxygen prevention and treatment of delayed radiation injuries: An evidence based approach. Undersea Hyperb Med. 2002;29:4–30
  17. Marx RE. A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg. 1983;41:351–357
  18. Bennett MH, Feldmeier J, Hampson N, et al. Hyperbaric oxygen therapy for late radiation tissue injury (Protocol). The Cochrane Database of Systematic Reviews. 2004;Issue 2, Article No. CD005005
  19. Rubin P, Constine LS, Fajardo LF, et al. Overview: Late effects of normal tissues (LENT) scoring system. Int J Radiat Oncol Biol Phys. 1995;31:1041–1042
  20. Wei J, Dunn R, Litwin M, et al. Development and validation of the Expanded Prostate Cancer Index Composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology. 2000;56:899–905
  21. Anderson B, Shelton DL. Axial length in hyperoxic myopia. Presented at the Ninth International Symposium on Underwater and Hyperbaric Physiology Undersea and Hyperbaric Medical Society, Bethesda, MD, 1987. p. 607–611.
  22. Hong JJ, Park W, Ehrenpreis ED. Review article: Current therapeutic options for radiation proctopathy. Aliment Pharmacol Ther. 2001;15:1253–1262
  23. Albert M, Tempany CM, Schultz D, et al. Late genitourinary and gastrointestinal toxicity after magnetic resonance image-guided prostate brachytherapy with or without neoadjuvant external beam radiation therapy. Cancer. 2003;98:949–954
  24. Chapuis P, Dent O, Bokey E, et al. The development of a treatment protocol for patients with chronic radiation-induced rectal bleeding. Aust NZ J Surg. 1996;66:680–685
  25. Zimmermann FB, Feldmann HJ. Clinical and pathological manifestations: Therapy and prophylaxis of acute and late injurious effects of radiation on the rectal mucosa. Strahlenther Onkol. 1998;174(Suppl. III):85–89
  26. Carr ND, Pullen BR, Hasleton PS, et al. Microvascular studies in human radiation bowel disease. Gut. 1984;25:448–454
  27. Capps GW, Fulcher AS, Szucs RA, et al. Imaging features of radiation-induced changes in the abdomen. Radiographics. 1997;17:1455–1473
  28. Charneau J, Bouachour G, Person B, et al. Severe hemorrhagic radiation proctitis advancing to gradual cessation with hyperbaric oxygen. Dig Dis Sci. 1991;36:373–375
  29. Mainous EG, Boyne PJ, Hart GB. Hyperbaric oxygen treatment of mandibular osteomyelitis: Report of three cases. JADA. 1973;87:1426–1430
  30. Marx RE. Osteoradionecrosis: A new chapter of its pathophysiology. J Oral Maxillofac Surg. 1983;41:283–288
  31. Bouachour G, Ronceray J, Bouali AB, et al. Hyperbaric oxygen in the treatment of radiation induced proctitis: A report on 8 cases. Proceedings of the Tenth International Congress on Hyperbaric Medicine, Amsterdam, 1990. p. 158–163.
  32. Haynes RB, Devereaux PJ, Guyatt GH. Clinical expertise in the era of evidence-based medicine and patient choice (Editorial). ACP J Club. 2002;136:A11
  33. Marx R. Radiation injury to tissue. In:  Kindwall E,  Whelan H editor. Hyperbaric medicine practice. 2nd ed., revised. Flagstaff, AZ: Best Publishing; 2004;p. 665–723
  34. Dempsey J, Hynes N, Smith T, et al. Cost effectiveness analysis of hyperbaric therapy in osteoradionecrosis. Can J Plast Surg. 1997;5:221–229
  35. Nakada T, Kubota Y, Sasagawa I, et al. Therapeutic experience of hyperbaric oxygenation in radiation colitis. Dis Colon Rectum. 1993;36:962–965
  36. Hamour AA, Denning DW. Hyperbaric oxygen therapy in a woman who declined colostomy. Lancet. 1996;348:197
  37. Feldmeier JJ, Heimbach RD, Davolt DA, et al. Hyperbaric oxygen an adjunctive treatment for delayed radiation injuries of the abdomen and pelvis. Undersea Hyperbaric Med. 1996;23:205–213
  38. Woo TCS, Joseph D, Oxer H. Hyperbaric oxygen treatment for radiation proctitis. Int J Radiat Oncol Biol Phys. 1997;38:619–622
  39. Warren DC, Feehan P, Slade JB, et al. Chronic radiation proctitis treated with hyperbaric oxygen. Undersea Hyperb Med. 1997;24:181–184
  40. Ugheoke EA, Norris T, Sharma VK, et al. Radiation proctitis (RTP): Is there a role for hyperbaric oxygen (HBO) therapy? Proceedings of the American College of Gastroenterology 63rd Annual Scientific Meeting, October 12–14, 1998, Boston, MA.
  41. Carl UM, Peusch-Dreyer D, Frieling T, et al. Treatment of radiation proctitis with hyperbaric oxygen: What is the optimal number of HBO treatments?. Strahlenther Onkol. 1998;174:482–483
  42. Gouello JP, Bouachour G, Person B, et al. The role of hyperbaric oxygen therapy in radiation-induced digestive disorders: 36 cases. Presse Med. 1999;28:1053–1057
  43. Kitta T, Shinohara N, Shirato H, et al. The treatment of chronic radiation proctitis with hyperbaric oxygen in patients with prostate cancer. BJU Int. 2000;85:372–374
  44. Bem J, Bem S, Singh A. Use of hyperbaric oxygen chamber in the management of radiation-related complications of the anorectal region. Dis Colon Rectum. 2000;43:1435–1438
  45. Roque F, Saraiva A, Simao G, et al. Hyperbaric oxygen therapy for late radio-induced intestinal lesions. Proceedings of the European Society for Therapeutic Radiology and Consensus Conference, Lisbon, Portugal, 2001. p. 105–121.
  46. Mayer R, Klemen H, Quehenberger F, et al. Hyperbaric oxygen—An effective tool to treat radiation morbidity in prostate cancer. Radiother Oncol. 2001;61:151–156
  47. Boyle BR, Moon RE, Stolp BW, et al. Hyperbaric oxygen therapy for chronic radiation proctitis (CRP) [Abstract]. Undersea Hyperb Med. 2002;29(Suppl.):19
  48. Jones K, Evans AW, Bristow RG, et al. Treatment of radiation proctitis with hyperbaric oxygen. Radiother Oncol. 2006;78:91–94
  49. Dall'Era MA, Hampson NB, His RA, et al. Hyperbaric oxygen therapy for radiation induced proctopathy in men treated for prostate cancer. J Urol. 2006;176:87–90
  50. Fink D, Chetty N, Lehm JP, et al. Hyperbaric oxygen therapy for delayed radiation injuries in gynecological cancers. Int J Gynecol Cancer. 2006;16:638–642
  51. Girnius S, Cersonsky N, Gesell L, et al. Treatment of refractory radiation-induced hemorrhagic proctitis with hyperbaric oxygen therapy. Am J Clin Oncol. 2006;29:588–592
  52. Nakabayashi M, Beard C, Kelly SM, et al. Treatment of a radiation-induced rectal ulcer with hyperbaric oxygen therapy in a man with prostate cancer. Urol Oncol Semin Orig Invest. 2006;24:503–508
  53. Marshall GT, Thirlby RC, Bredfeldt JE, et al. Treatment of gastrointestinal radiation injury with hyperbaric oxygen. Undersea Hyperb Med. 2007;34:35–42

 Supported in part by grants from the Lotte and John Hecht Memorial Foundation and National Baromedical Services, and equipment from Sechrist Industries.

 Supplementary material (Table 3) for this article can be found at www.redjournal.org.

 Presented in part at the Undersea and Hyperbaric Medical Society Annual Scientific Meeting, Sydney, Australia, May 27–30, 2004; the Hyperbaric Nurses and Technicians Association Annual Meeting, Adelaide, Australia, August 9–11, 2007; and the Undersea and Hyperbaric Medical Society Gulf Coast Chapter Annual Scientific Meeting, Nashville, Tennessee. September 1, 2007.

 Conflict of interest: R. E. Clarke provides hyperbaric medicine support services; and S. D. Rodrigues was compensated for lectures by Roche in 2007 and sat on the pain management board of Jansen Cilag in 2006.

PII: S0360-3016(08)00042-4

doi: 10.1016/j.ijrobp.2007.12.048

International Journal of Radiation Oncology * Biology * Physics
Volume 72, Issue 1 , Pages 134-143.e15 , 1 September 2008