cancer treatment side effects - radiation cystitis

by Dr. Donna Douglas

Hyperbaric chambers have long been used by divers to treat and prevent ‘the bends’- a painful condition characterized by bubbles of gas trapped in the tissues. But oxygen therapy has found a relatively new application in cancer symptom management.

Radiation is a common type of treatment for local control of cancer. It is often necessary to include a margin of normal tissue around the tumour to allow for internal tumor motion and complete coverage of the tumor area. Radiation therapy also affects organs and tissues in the path of the radiation beam on the way to target site. This damage is a side effect of treatment.

Radiation side effects are divided into early and late effects. Early or acute symptoms are caused by the inflammatory response to radiation and are similar to any inflammatory response. Late phase or chronic symptoms (usually after 6 months) are the end result of the inflammatory process. Radiation causes changes in blood vessels. Swelling and thickening may progressively reduce the blood supply to the irradiated tissue. Collagen deposits may also cause severe scarring and further blood vessel damage resulting in tissue death. Ulcers, inflammation and fibrous growth are the main factors responsible for pain and discomfort. New symptoms can occur years after initial therapy and these symptoms depend on the area treated.

Irradiation Area	Possible Side Effects
Chest wall	Heart attack
Stomach, Abdomen	Vomiting, nausea, diarrhea, reproductive and sexual issues
Pelvis	Digestive problems
Head and Neck	Difficulty swallowing, changes in taste, dry mouth, sleepiness, confusion
	Immuno-suppression

Of particular concern recently was the finding that breast cancer patients treated with earlier radiation protocols were at risk for cardiovascular disease, particularly when the left breast was treated. Damage from the radiation leads to narrowing of the heart arteries, and may cause a heart attack.

Hyperbaric Oxygen Therapy
In 1985, researchers published the first findings of microscopically documented healing of radiation-induced bladder injury using hyperbaric oxygen therapy (Weiss). It took almost 10 years for its use to be further investigated and confirmed (Lee). Hyperbaric treatment for radiation cystitis is now an FDA approved use for the technology.

The air we breathe is 21 percent oxygen. This can be increased to 100 percent with mask breathing. However, the body’s internal oxygen can be increased by two to three times by administering oxygen under pressure in a hyperbaric chamber. This high dose of oxygen is dissolved in the blood supply and carried to the site of injury to repair tissues and damaged blood vessels. Treatment also increases the functioning of white (immune) blood cells. Over 80 percent of treated patients achieve complete resolution or marked improvement.

Side effects
Claustrophobia may be a factor in small hyperbaric chambers. However, some medical centers have spacious chambers which accommodate multiple individuals in reclining lounge chairs.

Other complications can include myopia (short sightedness) which usually resolves in a few weeks, sinus damage, ruptured middle ear, and lung damage. A complication called oxygen toxicity can result in fluid in the lungs and respiratory effects. Patients at high risk of oxygen toxicity may be given “air breaks” during which they breathe room air rather than oxygen for short periods during treatment. Complications are minimized when pressures remain below three times normal atmospheric pressure and sessions last no longer than two hours.

References

Chong, KT. Early hyperbaric oxygen therapy improves outcome for radiation-induced hemorrhagic cystitis. Urology. 2005 Apr;65(4):649-53.

Doyle, JJ. Radiation therapy, cardiac risk factors, and cardiac toxicity in early-stage breast cancer patients. Int J Radiat Oncol Biol Phys. 2007 May 1;68(1):82-93.

Fink, D. Hyperbaric oxygen therapy for delayed radiation injuries in gynecological cancers. Int J Gynecol Cancer. 2006 Mar-Apr;16(2):638-42.

Hooning, MJ. Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst. 2007 Mar 7;99(5):365-75.

Jagsi, R. Rates of myocardial infarction and coronary artery disease and risk factors in patients treated with radiation therapy for early-stage breast cancer. Cancer. 2007 Feb 15;109(4):650-7.

Lee, HC. Hyperbaric oxygen therapy in hemorrhagic radiation cystitis: a report of 20 cases. Undersea Hyperb Med. 1994 Sep;21(3):321-7.

Neheman, A. Hyperbaric oxygen therapy for radiation-induced haemorrhagic cystitis. BJU Int. 2005 Jul;96(1):107-9.

Weiss, JP. Treatment of radiation-induced cystitis with hyperbaric oxygen. J Urol. 1985 Aug;134(2):352-4.

Nicolas A Muruve, MD, FRCSC, FACS, Associate Staff, Department of Urology, Cleveland Clinic Florida “Radiation Cystitis”. Accessed Aug. 11, 2007.

Treatment of radiation-induced cystitis with hyperbaric oxygen. Energy Citations Database. J. Urol. ; Vol/Issue: 2. http://www.osti.gov/energycitations/product.biblio.jsp?osti_id=5094210

Posted June 2007