Christian Hyde, Presenter: Nothing to Disclose

Joan Eggert MD, Abstract Co-Author: Nothing to Disclose

Nicholas Bird MD, Abstract Co-Author: Nothing to Disclose

Diane Tracy PhD, Abstract Co-Author: Nothing to Disclose

PURPOSE/OBJECTIVE(S): To measure the effectiveness of hyperbaric oxygen therapy (HBOT) among community hospital prostate cancer patients with severe late radiation side effects, utilizing a modified SOMA-LENT score system. A secondary objective was to analyze any association of different radiation techniques with severe late effects.MATERIALS/METHODS: We retrospectively reviewed pelvic radiation therapies and subsequent interventions in 19 prostate cancer patients with Grade 3 (severe) or Grade 4 (life threatening) gastrointestinal or genitourinary late effects. Three of the 19 men had non-healing recto-vesicle or recto-urethral fistulas. Five of the 19 required transfusions, 7 patients had undergone bladder or rectal fulguration, argon beam coagulation, or cauterization due to bleeding telangiectasias or ulcers. Six men had chronic suprapubic or Foley catheter placement due to urethral necrosis or intractable hematuria with clots. Six patients had transurethral resection (TURP) or microwave ablation (TUMT) of prostate for treatment of bladder neck contracture, stricture, obstruction or urethral necrosis. Many patients had more than one severe late effect, such as both hematuria and hematochezia. We prospectively employed a modified SOMA-LENT scoring system to measure symptom severity before and after a median of 39 hyperbaric oxygen treatments.RESULTS: A statistically significant improvement in dysuria (p=0.008) and hematuria (p<0.0001) was found after HBOT, with non-statistically significant improvement in hematochezia and diarrhea (p>0.05). The modified SOMA-LENT scoring system was practical to use in a community hospital setting and sensitively detected improvements despite the small sample size. HBOT was well tolerated and without significant adverse events. Analysis of radiation techniques revealed 8 patients had external beam radiation therapy (EBRT) alone with 6600 to 7500 cGy. 2 patients had High Dose Rate (HDR) brachytherapy alone. A plurality of 9 patients had brachytherapy plus EBRT, as did 2 of 3 fistula patients, despite such combined modality treatment representing a very small minority of patients irradiated nationwide for prostate cancer.CONCLUSIONS: Patients with severe late effects were likely to have had a combination of radiation modalities with external beam plus brachytherapy. Invasive procedures in radiated tissue often preceded fistulas or severe bleeding. HBOT was effective in controlling post-radiation dysuria and hematuria, as documented by the SOMA-LENT scoring system.

Hyde, C, Eggert, J, Bird, N, Tracy, D, Hyperbaric Oxygen for Prostate Cancer Radiation Late Effects.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11030121.html