The effectiveness of hyperbaric oxygen therapy (HBOT) in radiation-induced haemorrhagic cystitis.

INTRODUCTION: Radiation cystitis is one of the possible complications from pelvic radiotherapy. Hyperbaric oxygen (HBOT) improves tissue oxygenation and healing of scarred tissue. AIMS: To assess the efficacy of hyperbaric oxygen therapy (HBOT) in the management of radiation-induced haemorrhagic cystitis in patients with urological cancers. METHODS: This is a retrospective review on all patients with macroscopic haematuria secondary to radiation induced haemorrhagic cystitis who were treated with hyperbaric oxygen therapy (HBOT) between 2009 and 2013. The primary outcome is symptomatic assessment (either complete resolution, partial resolution or no change). RESULTS: A total of 12 patients with radiation-induced cystitis secondary to urological cancer were included in this study with a mean follow-up of 443 days. The mean age was 78 years. Complete resolution of haematuria was seen in six out of 12 patients. Partial response was achieved in two patients where one required two courses of HBOT and one required three courses of HBOT. As a result, the overall improvement of haematuria after HBOT was 67%. A total of four patients had no response to HBOT. CONCLUSION: Radiation-induced cystitis is a difficult clinical problem to treat. HBOT is not a magic bullet but it may be another alternative treatment option we have at this point in time.

Prognostic significance of parapharyngeal space venous plexus and marrow involvement: potential landmarks of dissemination for stage I-III nasopharyngeal carcinoma.

PURPOSE: To determine whether the parapharyngeal space venous plexus and marrow of the skull base bones are anatomic landmarks of the potential routes for the spread of disease for Stage I-III (American Joint Commission on Cancer 1997 staging system) nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: A total of 364 patients with NPC were enrolled in this study. The selection criteria were Stage I-III disease and primary radiotherapy at our hospital between 1990 and 2001. All patients had undergone MRI to evaluate the head-and-neck tumors. Patients who had undergone inadequate radiotherapy at a dose of <60 Gy and/or preradiotherapy chemotherapy before the imaging evaluation were excluded from the study. RESULTS: Of the 364 patients treated between 1990 and 2001, 163 (44.8%) had low-risk Stage I-III NPC (without parapharyngeal space extension or T3 disease). The 5-year distant metastasis-free survival rate, with and without adjuvant chemotherapy, was 97% and 96%, respectively. The remaining 201 patients had Stage II-III with parapharyngeal space extension or T3 disease. Their 5-year recurrence-free survival rate, with and without adjuvant chemotherapy, was 76.8% and 53.2% (p = 0.01), respectively. CONCLUSION: Our findings suggest that the risk of distant metastasis in Stage I-III NPC patients without parapharyngeal space extension or T3 disease is extremely low. Invasion into the parapharyngeal space venous plexus and marrow of the skull base bones is associated with distant metastasis, and involvement of these anatomic sites is considered a potential route for hematogenous disease spread in patients with Stage I-III NPC.