Dellis Athanasios, Deliveliotis Charalambos, Kalentzos Vasileios, Vavasis Pavlos, Skolarikos Andreas
2nd Surgical Department, University of Athens, Aretaieion Hospital, Athens, Greece.
2nd Urologic Department, University of Athens, Sismanoglio General Hospital, Athens, Greece.
Int Braz J Urol. 2014 May-Jun;40(3):296-305. doi: 10.1590/S1677-5538.IBJU.2014.03.02.
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.
探讨高压氧作为IV级放射性出血性膀胱炎主要治疗方法的安全性和有效性。
前瞻性地将高压氧作为11例IV级放射性膀胱炎患者的主要治疗选择。主要终点是治疗的完全缓解率和部分缓解率。次要终点包括缓解持续时间、治疗成功率与血尿发作至治疗开始间隔的相关性、输血需求和总辐射剂量、达到成功所需的治疗次数、避免手术以及总生存期。
所有患者均完成治疗，无并发症，平均随访17.82个月（范围3至34个月）。所需治疗的平均次数为32.8次（范围27至44次）。完全缓解率和部分缓解率分别为81.8%和18.2%。然而，3例患者的首次治疗疗程既不充分也不持久，持久有效率为72.7%。有趣的是，所有9例完全缓解的患者在血尿发作后6个月内接受了治疗，而2例部分缓解的患者分别在血尿发作后8个月和10个月接受了治疗（p = 0.018）。输血需求（p = 0.491）和总辐射剂量（p = 0.259）与成功率无关。1例患者需要进行膀胱切除术，所有患者在随访结束时均存活。
早期将高压氧作为主要治疗方法用于治疗放射性IV级膀胱炎是一种有效且安全的治疗选择。
