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The effectiveness of hyperbaric oxygen therapy for managing radiation-induced proctitis : a retrospective study
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Introdução: Apesar das modernas técnicas de radioterapia (RT), a proctite rádica (PR) continua a ser uma das complicações tardias mais comuns da RT dirigida ao cancro pélvico. Este estudo tem como principal objetivo avaliar a eficácia e a segurança da oxigenoterapia hiperbárica (OHB) no tratamento da PR. Métodos: Análise retrospetiva de dez anos (2013-2023) que engloba todos os doentes com PR tratados com OHB no Centro de Medicina Subaquática e Hiperbárica (CMSH) (Hospital das Forças Armadas – Lisboa, Portugal). Os doentes foram expostos a 100% de oxigénio a 2,5 ATA, em câmara hiperbárica multilugar, por períodos diários de 70 minutos, cinco vezes por semana. A análise estatística foi realizada através do software IBM® SPSS Statistics 23.0; p<0,05 foi aceite como estatisticamente significativo. Resultados: De um total de 151 doentes, 88 foram incluídos na análise final, dos quais 38,6% evidenciaram presença de outras lesões rádicas tardias concomitantes. A neoplasia primária mais observada foi o cancro da próstata (77,3%). A manifestação clínica mais reportada foi o desenvolvimento de hematoquézia (86,4%). Após uma mediana de 60 sessões de OHB (intervalo interquartil [IIQ]: 40-87.5), 62,5% e 31,8% dos doentes atingiram resposta clínica completa e parcial, respetivamente, registando-se uma taxa de resolução de hematoquézia de 93,7% (completa ou parcial). Em termos de sintomatologia global da PR, a obtenção da resposta clínica completa ou parcial requereu, tendencialmente, menos de 70 sessões (p=0,069); já para a resolução isolada da hematoquézia, foram necessárias, pelo menos, 70 sessões (p=0,075). Apenas 5,7% dos doentes não respondeu ao tratamento e o efeito secundário mais frequente foi o barotraumatismo do ouvido médio (n=18). O número de sessões de OHB constituiu um fator preditor da ocorrência de efeitos secundários associados ao tratamento (odds ratio: 1,010; intervalo de confiança de 95%, 1,000-1,020; p=0,047). Conclusões: A OHB provou ser um tratamento eficaz e seguro no tratamento da PR refratária a tratamento médico e/ou endoscópico. Este estudo acrescenta valor à evidência atual publicada.
Background: Despite modern radiation therapy (RT) techniques, radiation-induced proctitis (RIP) remains one of the most common complications of RT to pelvic organ malignancies. This study aims to evaluate the effectiveness and safety of hyperbaric oxygen therapy (HBOT) in the treatment of RIP. Methods: Ten-year (2013-2023) retrospective analysis of all consecutive patients with RIP treated with HBOT at Centro de Medicina Subaquática e Hiperbárica (CMSH) (Armed Forces Hospital – Lisbon, Portugal). Patients were exposed to 100% oxygen at 2.5 ATA, in a multiplace first class hyperbaric chamber, for 70-min periods, once daily, five times per week. Statistical analysis was performed using IBM® SPSS Statistics 23.0 software; p<0.05 was accepted as statistically significant. Results: Of a total of 151 patients with RIP, 88 were included in the final analysis, of whom 38.6% evidenced other concurrent radiation-induced soft tissue lesions. The most reported primary pelvic tumour was prostate cancer (77.3%). Haematochezia was the most observed clinical manifestation (86.4%). After a median of 60 HBOT sessions (interquartile range [IQR]: 40-87.5), 62.5% and 31.8% of patients achieved a clinical complete and partial response, respectively, with a haematochezia resolution rate of 93.7% (complete or partial). While partial and complete responses tend to require fewer than 70 HBOT sessions in terms of overall RIP symptoms (p=0.069), isolated haematochezia tends to require at least 70 sessions (p=0.075). Only about 5.7% of patients did not respond to the treatment. Eighteen patients developed reversible ear barotrauma. The number of HBOT sessions was a predictor of HBOT side effects (odds ratio: 1.010; 95% confidence interval, 1.000-1.020; p=0.047). Conclusions: HBOT proved to be an effective and safe treatment for RIP refractory to medical and/or endoscopic treatments. This real-world evidence study adds value to published data on the management of RIP with HBOT.
Background: Despite modern radiation therapy (RT) techniques, radiation-induced proctitis (RIP) remains one of the most common complications of RT to pelvic organ malignancies. This study aims to evaluate the effectiveness and safety of hyperbaric oxygen therapy (HBOT) in the treatment of RIP. Methods: Ten-year (2013-2023) retrospective analysis of all consecutive patients with RIP treated with HBOT at Centro de Medicina Subaquática e Hiperbárica (CMSH) (Armed Forces Hospital – Lisbon, Portugal). Patients were exposed to 100% oxygen at 2.5 ATA, in a multiplace first class hyperbaric chamber, for 70-min periods, once daily, five times per week. Statistical analysis was performed using IBM® SPSS Statistics 23.0 software; p<0.05 was accepted as statistically significant. Results: Of a total of 151 patients with RIP, 88 were included in the final analysis, of whom 38.6% evidenced other concurrent radiation-induced soft tissue lesions. The most reported primary pelvic tumour was prostate cancer (77.3%). Haematochezia was the most observed clinical manifestation (86.4%). After a median of 60 HBOT sessions (interquartile range [IQR]: 40-87.5), 62.5% and 31.8% of patients achieved a clinical complete and partial response, respectively, with a haematochezia resolution rate of 93.7% (complete or partial). While partial and complete responses tend to require fewer than 70 HBOT sessions in terms of overall RIP symptoms (p=0.069), isolated haematochezia tends to require at least 70 sessions (p=0.075). Only about 5.7% of patients did not respond to the treatment. Eighteen patients developed reversible ear barotrauma. The number of HBOT sessions was a predictor of HBOT side effects (odds ratio: 1.010; 95% confidence interval, 1.000-1.020; p=0.047). Conclusions: HBOT proved to be an effective and safe treatment for RIP refractory to medical and/or endoscopic treatments. This real-world evidence study adds value to published data on the management of RIP with HBOT.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Oxigenoterapia hiperbárica Lesão rádica Proctite rádica Cistite rádica Radioterapia Oncologia