Hyperbaric oxygen therapy for radiation induced proctopathy in men treated for prostate cancer
Hyperbaric oxygen therapy for radiation induced proctopathy in men treated for prostate cancer
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DOI：
10.1016/s0022-5347(06)00491-5
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发表时间：
2006-07-01
影响因子：
6.6
通讯作者：
Corman, John M.
中科院分区：
文献类型：
--
作者：
Dall'Era, Marc A.;Hampson, Neil B.;Corman, John M.
目的：放射性直肠炎是前列腺癌外照射和近距离放射治疗后常见的并发症。虽然95%的放射性直肠炎是暂时的和自限性的，但高达5%的患者会出现保守治疗难以治愈的毒性。高压氧在治疗慢性创伤、骨髓炎、出血性膀胱炎和坏死性筋膜炎方面具有明确的作用。我们回顾了高压氧治疗前列腺癌放射治疗患者放射性直肠炎的经验。材料和方法：从1998年10月至2003年12月，27例放射性直肠炎患者继发于近距离放射治疗（4），在西雅图的弗吉尼亚梅森医疗中心，华盛顿。所有患者的初级医疗或内镜治疗均失败。患者在2.4个大气压绝对压力的多位高压舱中接受100%氧气，每周5至7天，平均36次（范围29至60）。数据收集从一个回顾性审查的医疗记录批准后，由机构审查委员会在弗吉尼亚梅森医疗center.Results：所有27名男子完成了计划的治疗过程。在出血患者中，48%的患者在治疗后完全消退，而28%的患者报告出血事件明显减少。50%的患者注意到粪便紧迫感完全消退。8例疼痛患者中有6例（75%）在治疗后出现了一些改善，但没有患者报告直肠疼痛完全消退。在直肠溃疡患者中，21%的患者在治疗后内窥镜检查中显示溃疡完全消退，而29%的患者显示出改善的证据。6例患者（43%）直肠溃疡无变化或恶化。总体而言，67%的患者有一个部分良好的反应，而33%没有反应或疾病progress.Conclusions：这一系列的患者表现出良好的整体反应率高压氧放射性直肠病后，其他尝试管理失败。高压氧通常耐受性良好，仍然是管理这种常见和困难疾病的重要治疗选择。
Purpose: Radiation proctitis is a common complication following external beam radiation therapy and brachytherapy for prostate cancer. While 95% percent of radiation induced proctitis is temporary and self-limiting, up to 5% of patients experience toxicities that are refractory to conservative management. Hyperbaric oxygen has a well-defined role in treating chronic wounds, osteomyelitis, hemorrhagic cystitis and necrotizing fasciitis. We reviewed our experience with hyperbaric oxygen therapy for radiation induced proctitis in patients undergoing radiation treatment for prostate cancer.Materials and Methods: From October 1998 to December 2003, 27 patients with radiation induced proctitis secondary to brachytherapy (4), external beam radiation therapy (16) or combined modality (7) for prostate cancer were treated with hyperbaric oxygen therapy at Virginia Mason Medical Center in Seattle, Washington. In all patients primary medical or endoscopic management had failed. Patients received 100% oxygen in a multiplace hyperbaric chamber at a pressure of 2.4 atmospheres absolute for 90 minutes 5 to 7 days weekly for an average of 36 sessions (range 29 to 60). Data were collected from a retrospective review of medical records following approval by the Institutional Review Board at Virginia Mason Medical Center.Results: All 27 men completed the planned course of therapy. Of patients with bleeding 48% showed complete resolution after therapy, while 28% reported significantly fewer bleeding episodes. Of patients 50% noted complete resolution of fecal urgency. Six of the 8 patients (75%) with pain noticed some improvement after therapy, although no patients reported complete resolution of rectal pain. Of patients with rectal ulceration 21% showed complete resolution of the ulcer on posttreatment endoscopy, while 29% showed evidence of improvement. Six patients (43%) had no change or worsening of rectal ulcers. Overall 67% of patients had a partial to good response, while 33% showed no response or disease progression.Conclusions: This series of patients showed a good overall response rate to hyperbaric oxygen for radiation induced proctopathy after other attempts at management had failed. Hyperbaric oxygen is generally well tolerated and it remains an important treatment option for managing this common and difficult disease.