Hyperbaric oxygen for radiation cystitis
Mené sur 87 patients atteints d'un cancer et souffrant d'une cystite induite par la radiothérapie, cet essai de phase II/III évalue l'efficacité, du point de vue de l'évolution des symptômes urinaires rapportés par le patient, et la toxicité d'une oxygénothérapie hyperbare
Delayed cystitis secondary to therapeutic radiation is an uncommon but serious complication that, in its most serious expression, is likely to require multiple serial blood transfusions and can even be lethal. Treatment with chemical and electrocautery is frequently employed but the cystitis is subject to frequent recurrence. In The Lancet Oncology, Nicklas Oscarsson and colleagues 1
present the results of a randomised, controlled trial reporting the effects of hyperbaric oxygen therapy in the treatment of moderately severe radiation-induced cystitis. This work is the culmination of years of effort in recruiting patients by five Nordic university medical centres to this well-designed and very important trial. Eventually, and not including patients who withdrew immediately after randomisation, 41 patients assigned to hyperbaric oxygen therapy and 38 controls were available for intention-to-treat analysis. All but one patient in the intervention group completed their course of hyperbaric oxygen, consisting of 30–40 daily treatments at 240–250 kPa for 80–90 min of 100% oxygen at pressure. Patients in the control group received standard care, the nature of which was not specified in the study report. Primary outcome measures consisted of self-assessed urinary symptoms before and 4–6 months after therapy assessed with the Extended Prostate Index Composite (EPIC) score, and general health-related quality of life assessed with 36-item Short Form (SF-36) questionnaire. Additionally, cystoscopies were done before and after the intervention, with findings from the gross bladder mucosa assessed by urologists masked to treatment assignment and compared with the Radiation Therapy Oncology Group's Morbidity Grading System. Biopsies of the bladder mucosa were also taken to be analysed and reported later.
The Lancet Oncology , commentaire, 2018