Hyperbaric Oxygen Therapy for Late Rectal and Bladder Toxicity after Radiation in Prostate Cancer Patients. A Symptom Control and Quality-of-life Study

Sir d Radiation therapy achieves a high level of disease control and cure rates for organ-confined prostate cancer [1], but a 5e20% incidence of late rectal/bladder toxicity can be expected [2]. The aim of our study was to investigate the effects of hyperbaric oxygen therapy (HBOT) on symptom control and quality of life for late radiation proctitis and/or cystitis. Between June 2006 and June 2008, 257 consecutive patients were studied who had been treated with radiation therapy for prostate cancer. Clinical, pharmacological and dosimetric parameters were collected for all patients in order to study prognostic factors. Patients with grade 2 toxicity were entered onto an HBOT treatment programme, which includes clinical measures of toxicity (by means of the CTCv3 and SOMA-LENT grading systems) and quality of life (using the SF36 tests before and after HBOT and every 6 months thereafter). Late grade 2 rectal and/or bladder toxicity were diagnosed in 24 (9.3%) patients. In total, 14 patients were treated with HBOT; 10 non-bleeders were not considered for HBOT. Toxicity values measured by SOMA-LENT before HBOT, immediately afterwards and 6 months later showed a statistically significant improvement after HBOT. Rectal: 6.54 � 1.66, 1.54 � 1.33 and 0.54 � 1.13 (P ¼ 0.000). Bladder: 8.25 � 4.58,1.75 � 1.71 (P ¼ 0.037) and 0.75 � 0.96 (P ¼ 0.018); SF36 at the same intervals comparing the eight original components (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional and mental health) showed statistically significant improvement in five of them: physical functioning, role physical, social functioning, role emotional and mental health. The use of HBOT was a very effective treatment for ameliorating symptoms, particularly bleeding, and quality of life in patients suffering from late rectal and bladder toxicity. As far as we know, only the study published by Clark et al. [3] has presented data for SOMA-LENT measures in patients treated with HBOT.