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Hyperbare Sauerstofftherapie bei hämorrhagischer Strahlenzystitis nach Prostatakarzinom

Hyperbaric oxygen in the treatment of hemorrhagic radiogenic cystitis after prostate cancer

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Zusammenfassung

Hintergrund

Die radiogene Zystitis stellt eine Spätfolge der Strahlentherapie dar, von der 3–6% der Patienten betroffen sind. Die hyperbare Sauerstofftherapie (HBO) bietet eine vielversprechende Alternative bei therapierefraktärer hämorrhagischer Strahlenzystitis. Diese Arbeit präsentiert unsere Ergebnisse der HBO-Therapie bei hämorrhagischer Strahlenzystitis nach Prostatakarzinom.

Methoden

Es erfolgte die retrospektive Evaluation aller Patienten, die von 2006–2012 wegen hämorrhagischer Zystitis mit HBO behandelt wurden. Die HBO wurde für 130 min/Tag bei 1,4 bar Überdruck durchgeführt. Dokumentiert wurden die Bestrahlungsart, der Beginn und die Schwere der Hämaturie, die Dauer bis zur HBO und die HBO-Kennzahlen. Der HBO-Effekt wurde als kompletter Rückgang der Symptome oder als niedrigerer RTOG/EORTC-Hämaturiegrad definiert.

Ergebnisse

Bei 10 Patienten (medianes Alter 75 Jahre) erfolgten median 30 HBO-Therapien bei hämorrhagischer Zystitis. Die Bestrahlungen wurden als primäre, adjuvante, Salvage- oder HDR-Brachytherapie (60–78 Gy) durchgeführt. Die Hämaturie trat im Median 41 Monate nach Radiatio auf. Die HBO erfolgte im Median 11 Monate nach Beginn der Hämaturie. Nach einem Follow-up von im Median 35 (2–71) Monaten waren 80% beschwerdefrei, ein Patient erlitt erneute eine einmalige Hämaturie und bei einem Patienten war eine Salvagezystektomie notwendig. Nebenwirkungen oder Folgeschäden traten nicht auf.

Zusammenfassung

Unsere Erfahrungen weisen darauf hin, dass HBO bei therapierefraktärer Strahlenzystitis eine sichere und effektive Therapieoption darstellt. Zur weiteren Evaluation wären prospektive Studien wünschenswert, erscheinen aber kaum realisierbar.

Abstract

Background

Postradiation hemorrhagic cystitis is a well known long-term complication of radiation therapy occurring in 3–6 % of patients. Hyperbaric oxygen (HBO) has been demonstrated to be an effective treatment for radiation-induced hemorrhagic cystitis not responding to conventional management. This article reviews experiences with HBO for radiogenic cystitis after prostate cancer.

Methods

All patients treated for hemorrhagic cystitis with HBO between 2006 and 2012 were retrospectively reviewed. The HBO procedure was performed for 130 min/day at 1.4 atmospheres overpressure. Patient demographics, type of radiotherapy, onset and severity of hematuria and time between first hemorrhagic episode and beginning of HBO were evaluated. The effect of HBO was defined as complete or partial (lower RTOG/EORTC grade) resolution of hematuria.

Results

A total of 10 patients with radiogenic cystitis and a median age of 76 years were treated with a median of 30 HBO treatment sessions. Patients received primary, adjuvant, salvage and high dose rate (HDR) radiotherapy (60–78 Gy). First episodes of hematuria occurred after a median of 41 months following completion of radiotherapy and HBO was performed 11 months after the first episode of hematuria. After a median 35-month follow-up 80% experienced complete resolution, one patient suffered a one-off new hematuria and in one patient a salvage cystectomy was necessary. No adverse effects were documented.

Conclusions

The experiences indicate that HBO is a safe and effective therapy option in treatment-resistant radiogenic cystitis but prospective clinical trials are needed for a better evaluation.

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Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Universität Witten/Herdecke, Heusnerstraße 40, 42283, Wuppertal, Deutschland

    S. Degener, D.A. Lazica, S. Roth & A.S. Brandt

  2. Klinik für Urologie, Klinikum Leverkusen, Leverkusen, Deutschland

    A. Pohle & J. Zumbé

  3. Hyperbare Sauerstofftherapie (HBO), Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    H. Strelow & J. Windolf

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  1. S. Degener
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  2. H. Strelow
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  3. A. Pohle
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  4. D.A. Lazica
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  5. J. Windolf
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  6. J. Zumbé
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  7. S. Roth
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  8. A.S. Brandt
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Correspondence to S. Degener.

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Degener, S., Strelow, H., Pohle, A. et al. Hyperbare Sauerstofftherapie bei hämorrhagischer Strahlenzystitis nach Prostatakarzinom. Urologe 51, 1735–1740 (2012). https://doi.org/10.1007/s00120-012-3036-x

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  • DOI: https://doi.org/10.1007/s00120-012-3036-x

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