The Effects of Hyperbaric Oxygen Therapy on Pelvic Radiation Induced Gastrointestinal Complications (Rectal Bleeding, Diarrhea, and Pain): A Meta-Analysis

Abstract

Background: Radiotherapy is a routine treatment for pelvic cancer patients. While it had been proven effective, gastrointestinal side effects remain a concern, impairing the quality of life. A few studies focused on the effects of hyperbaric oxygen (HBO) treatment to alleviate radiation-induced gastrointestinal complications. This meta-analysis aimed to critically review and summarize existing literature, assessing the effectiveness of HBO therapy for the treatment of radiation-induced gastrointestinal side effects. Methods: Medical literature search was performed with PubMed, Cochrane Library, and EMBASE up to March 14, 2019. Literatures about HBO treatment upon patients undergoing pelvic cancer (endometrial, cervix, rectum, or prostate cancers) radiotherapy were collected, and the effects of HBO treatment on radiotherapy-induced gastrointestinal complications were evaluated. A random-effects model was used to calculate the pooled effect size. Subgroup analyses were performed to search for sources of heterogeneity. Publication bias was detected with Funnel plots and Egger's test. Results: Three different radiotherapy-related gastrointestinal complications, including rectal bleeding, diarrhea, and pain, were analyzed after screening. It was revealed that the improvement rates were considerable in rectal bleeding (0.81, 95% CI: 0.74-0.89) and diarrhea (0.75, 95% CI: 0.61-0.90) and slightly in pain (0.58, 95% CI: 0.38-0.79). Subgroup analysis revealed factors that significantly influenced the heterogeneity of rectal bleeding, diarrhea, and pain (evaluation criteria, follow-up time, and scoring system, respectively). No significant publication bias was detected. Conclusion: HBO treatment might have the potential to alleviate radiotherapy-related gastrointestinal complications, including rectal bleeding, diarrhea, and pain, but more data are needed for further conclusions. Other symptoms were not further analyzed, as the number of studies was insufficient. More large-scale and prospective studies are needed for better evaluation of HBO's therapeutic values.

Pelvic Radiation Disease

“…13 HBO is effective, but use is often limited by issues of access and cost. 14 Surgery is usually reserved for patients with highly significant and debilitating bleeding, stricture, or fistula (see below) due to very high morbidity and mortality rates. 11 The ideal surgical approach, in particular the question of simple diversion versus formal resection, remains unclear.…”

Update on the management of the gastrointestinal effects of radiation

“…Hyperbaric oxygen therapy (HBOT) is a further medical option for management of rectal bleeding. It is purported to act through increased stimulation of damaged cells and improves the activity of free radicals[ 49 ]. Recommendation for the use of HBOT is based on data from a 2008 double blind crossover trial carried out by Clarke et al [ 50 ].…”

Gastrointestinal Toxicity of Pelvic Radiotherapy: Are We Letting Women Down?

“…A recent combined prospective and retrospective observational trial of 52 patients who had been treated with radiotherapy for cancers of the bowel, bladder, cervix, prostate and vulva found that hyperbaric oxygen therapy can be an effective and safe treatment for pelvic late tissue radiation injury [67]. Similarly, a systematic review [68] has summarised the efficacy of hyperbaric oxygen in the management of radiation-induced bleeding, diarrhoea and pain. These data, which included only one prospective study and two randomised controlled trials, are encouraging, but they lack consistency in scoring of symptoms and response criteria.…”