12 not appear to impact treatment outcomes of HBOT with complete remission rates of haematuria reported in cases from 15 to 82 years of (29,34,36,37,38,46) age . Conclusions drawn on the effect of HBOT on CHC/RHC were, in many studies, dened as complete (no further macro-haematuria during the period of follow-up), or partial resolution of haematuria (dened as a lower RTOG (description of radiation-caused side effects in a reproducible way)/EORTC (summary score, calculated from the mean of 13 of the 15 QLQ-C30 scales) or Gray score than before HBOT) with the long-term efciency and safety of HBOT creating an inviting option for patients suffering from RHC or (29,30,31,35,37,38,40,45). CHC Final thoughts The early administration of HBOT has demonstrated a higher effectiveness after onset of haematuria as (38,46) well as a decrease in the recurrence thereof . It is postulated that this is due to the fact that early intervention with HBOT may enhance tissue regeneration and prevent chronic sloughing and (36,44) scarring of hypoxic bladder tissue . It is emphasised further that treatment with HBOT does not cause damage to the bladder tissue, as may be the case with other treatment modalities (i.e: cystoscopic coagulation, or instillations with chemical agents), this; due to the fact that HBOT is the only treatment modality that promotes tissue (36,44) healing and angiogenesis . The benet of the addition of HBOT into radiation injury treatment protocols is that even if HBOT fails to resolve the symptoms of radiation cystitis, it causes no additional damage, and offers an option for other treatment modalities to be attempted. Hyperbaric Oxygen Therapy demonstrates itself as a valuable systemic treatment option particularly in patients with other radiation-induced conditions (i.e: proctitis, scar complications, etc.), as HBOT may (27,40) improve or resolve multiple conditions at once , with no need for a combination of several individual treatments. As ill-advised as it may be to delay treatment, HBOT presents itself as an excellent option for treatment of radiation effects as HBOT has proven to be effective in cases where several other conservative therapies have been exhausted. It is the opinion of the author that HBOT is a safe and effective treatment for radiation cystitis/proctitis, but in the South African setting, the availability of SAUHMA accredited HBOT facilities is limited. References 1. Rubin P. Frankelstein. J., Shapiro. D., (1992). Molecular biology mechanisms in the radiation induction of pulmonary injury syndromes. Int Journal of Radiation Oncol Biol Phys; 24: pp93-101 2. Janes. L.A., Iqbal. U., Vercruysse. G.A., (2024). A Case Of Local Radiation Injury In The Creation Of Lichtenburg Art, Journal of burn care & research: ofcial publication of the American Burn Association, 10.1093/jbcr/irae008 3. Trott. K.R., (1984). Chronic damage after radiation therapy: Challenge to radiation biology.Int. Radiation Oncol Biol Phys; 10: pp907-913 4. Rubin. P., Casarrett, G. W., (1968). Clinical Radiation Pathology. Vol 1, pp 58-61, Philadelphia Pa. WB Saunders. 5. Derr. W., Hendry. H., (2001). Consequential late effects in normal tissues. Radiotherapy and oncology, 61: pp223-31. 6. Haldar. S., Dru. C., Bhowmick. N.A., (2014). Mechanisms of hemorrhagic cystitis. Am J Clin Exp Urol; 2(3): pp199-208 7. Norkool. D.M., Hampson. N.B., Gibbons. R. P., Weissman. R M., (1993) , Hyperbaric oxygen therapy for radiation-induced hemorrhagic cystitis, J Urology;150 (2 Pt 1): pp332-334. 8. Corman. J.M., McClure. D., Pritchett. R., Kozlowski. P., Hampson. N.B., (2003). Treatment of radiation induced hemorrhagic cystitis with hyperbaric oxygen. J Urol; 169(6): pp2200 9. Levenback. C., Eifel. P.J., Burke. T.W., Morris. M., Gershenson. D.M., (1994). Hemorrhagic cystitis following radiotherapy for stage Ib cancer of the cervix. Gynecol Oncol; 55(2): pp206–210. 10. Mendenhall. W.M., Henderson. R.H., Costa. J.A., Hoppe. B.S., Dagan. R., Bryant. C.M., Nichols. R.C., Williams. C.R., Harris. S.E., Mendenhall. N.P., (2013) Hemorrhagic Radiation Cystitis. American journal of clinical oncology [Epub ahead of print]. 11. Lima. M.V., Ferreira. F.V., Macedo. F.Y., De Castro Brito. G.A., Ribeiro. R.A., (2007). Histological changes in bladders of patients submitted to ifosfamide chemotherapy even with mesna prophylaxis. Cancer Chemother Pharmacol; 59(5): pp643–650. 12. Korkmaz. A., Oter. S., Deveci. S., Goksoy. C., Bilgic. H., (2001). Prevention of further cyclophosphamide induced hemorrhagic cystitis by hyperbaric oxygen and mesna in guinea pigs. J Urol; 166(3): pp1119–1123. 13. Kalayoglu-Besisik. S., Abdul-Rahman. I.S., Erer. B., Yenerel. M.N., Oguz. F.S., Tunc. M,. (2003). Outcome after hyperbaric oxygen treatment for cyclophosphamideinduced refractory hemorrhagic cystitis. J Urol; 170(3): pp922. 14. Hughes. M.J., Davis. F.M., Mark. S.D., Spearing. R.L., (2002). Hyperbaric oxygen for cyclophosphamideinduced cystitis. Br J Haematol; 119(2): pp575. 15. Smit. S.G., Heyns. C.F., (2010). Management of radiation cystitis. Nat Rev Urol; 7(4): pp206–14. 16. Marx. R.E., Johnson. R.P., (1988). Problem wounds in oral and maxillofacial surgery: The role of hyperbaric oxygen. In: Davis JC, Hunt TK, editors. Problem Wounds: The Role of Oxygen edn. New York: Elsevir Science Publishing; pp65–123. 17. Mendenhall. W.M., Henderson. R.H., Costa. J.A., Hoppe. B.S., Dagan. R., Bryant. C.M., Nichols. R.C., Williams. C.R., Harris. S.E., Mendenhall. N.P., (2013). Hemorrhagic Radiation Cystitis. American journal of clinical oncology [Epub ahead of print]. 18. Crew. J.P., Jephcott. C.R., Reynard. J.M., (2001). Radiation-induced haemorrhagic cystitis. Eur Urol; 40(2): pp111–123. 19. Levenback. C., Eifel. P.J., Burke. T.W., Morris. M., Gershenson. D.M., (1994). Hemorrhagic cystitis following radiotherapy for stage Ib cancer of the cervix. Gynecol Oncol; 55(2): pp206–10. 20. Marx. R.E., (1983). Osteoradionecrosis; a new concept of pathophysiology. Journal of Oral Maxillofacial Surgery. 41: pp283-288 21. Marx. R.E., (1999). Radiation injury to tissue in; Kindwall. E.P., Hyperbaric Oxygen Medicine Practice, 2nd Ed. Flagstaff, Best Publishing. pp 665-723. 22. Marx. R.E., Ehler. W.J., Tayapongsak. P., Pierce. L.W., UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
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