Hyperbaric Therapy for Radiation-Induced Hemorrhagic Cystitis

Friday, June 23, 2017

Via Christi Wound Healing and Hyperbaric Therapy is addressing a side effect of cancer treatment.

Marilee McBoyle, MD, FACS, Medical Director of Via Christi Wound Healing and Hyperbaric Therapy, confers with a patient during his hyperbaric treatment.

Radiation-induced hemorrhagic cystitis can occur in patients who have had prior radiation therapy. Most often, radiation has been part of their treatment regimen for a prostate, rectal, bladder or gynecologic malignancy.

Though the radiation treatment was appropriate for the initial cancer diagnosis, a small subset of patients (3 to 5 percent) can develop hemorrhagic cystitis in subsequent months and years.

This occurs as, over the course of time, radiation may have a damaging effect on blood vessels, which leads to the lining of the bladder becoming ischemic. This causes the formation of ulcers, which can lead to bleeding. For some patients, as the bladder attempts to repair itself, neovascularization (i.e., the formation of new blood vessels) occurs. These vessels are fragile and not of normal consistency, and minimal trauma can cause these newly formed blood vessels to rupture and bleed.

This challenge for some patients may occur as early as six months after radiation treatments, while for others it can be a matter of years. In some cases, the bleeding will be self-limited and resolve, but a small subset (3 to 5 percent) will experience ongoing bleeding, with only short intervals of normal bladder control. For the patients who are profoundly affected, they encounter hospitalizations to undergo cystoscopies to empty the bladder of clots and control the bleeding, as well as to verify no further malignancy has developed. This urologic procedure allows visualization of inflammatory changes typically seen with radiation-induced cystitis. The patients often continue to need an indwelling Foley catheter.

In this setting, hyperbaric oxygen may be of benefit, as it provides increased oxygen under increased atmospheric pressure to the injured area. This allows for angiogenesis with newer, healthier vessels. Even though the hemoglobin is saturated with oxygen, the excess oxygen in the plasma can aid in the repair of damaged tissues. This is a benefit that differs from other treatment modalities and may provide the greatest improvement if implemented within six months of the onset of the hemorrhagic cystitis — sooner rather than later.

A patient undergoes hyperbaric oxygen treatment at Via Christi Wound Healing and Hyperbaric Therapy.

The team at Via Christi Wound Healing and Hyperbaric Therapy educates patients as to what they can expect when undergoing hyperbaric oxygen treatments. Rather than breathing 20 percent oxygen under one atmosphere of pressure, the patients in the hyperbaric oxygen chamber breathe 100 percent oxygen under two to two-and-a-half atmospheres of pressure. Patients may experience some of the same sensations as they would when traveling in an airplane or driving in the mountains. Many patients tolerate the hyperbaric oxygen treatment very well, but approximately 30 percent will experience ear pain that is significant enough to have ear tubes inserted.

Prior to the initiation of hyperbaric oxygen treatment, information needed to obtain insurance approval includes the prior dates of radiation therapy, the amount of radiation given and the number of treatments.

Marilee McBoyle, MD, FACS

Hyperbaric oxygen treatments typically take two hours. Forty treatments are initially requested and progress reassessment is made after 30 treatments to allow for continuation of the final 10 treatments.

“For the patients we’ve treated with radiation-induced hemorrhagic cystitis, it’s been exciting to see that during the course of their treatment, the Foley catheter can often be removed,” says Marilee McBoyle, MD, FACS, Medical Director of Via Christi Wound Healing and Hyperbaric Therapy. “Patients may still experience some incontinence, but this can usually be easily managed. This therapy truly improves patients’ quality of life!”

Patients typically require a referral from their urologist or primary care physician prior to being seen at the Via Christi Wound Center in Wichita. For questions, call 316-268-5881.