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Radiation Proctitis: Hyperbaric Oxygen Enjoys Authoritative Recognition

There is encouraging news on the HBO-late radiation injury front to share. Over the past 18 months, evidence based analyses have increasingly acknowledged the value of hyperbaric oxygen for treatment of chronic radiation proctitis.

Attribution: I, Tdvorak

The American Society of Colon and Rectal Surgeons 2018 Clinical Practice Guideline states, “Hyperbaric oxygen therapy is an effective treatment modality to reduce bleeding in patients with CRP”. They rate HBO’s Grade of Evidence as “Strong”, based upon moderate level evidence, thereby assigning Level 1B. This is only one level below the highest on a six point scoring scale. What I believe equally important is that only one other interventional treatment achieved this same rating and none exceeded it. Likewise, no medical therapy rated higher. Another key message in all of this is that every assessed intervention, with the exception of HBO, only addresses symptomatic states. This explains why “standard care” commonly results in a remitting-relapsing clinical course. HBO’s induction of angiogenesis serves to overcome the underlying pathophysiologic state, so the only disease modifying option available short of cystectomy, with that procedure’s resultant quality of life implications

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More recently, a 2019 “Special Article” on gastrointestinal radiation injury saw an updating of a Clinical Practice Guideline by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer. In it, they state that existing (2013) guidelines for hyperbaric oxygen as treatment for radiation proctitis remain unchanged, and assigned as evidence level II (the definition of which includes evidence obtained from at least one well-designed experimental study). This evidence level is again a single step below the highest of a four categories. Their 2013 guideline was the first to reference HBO, and in doing so, judged it to represent “…an effective means of treating radiation-induced proctitis”.

So indeed good news and information worth sharing with gastroenterology and radiation oncology colleagues, and cancer patient clinical navigators.

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