Treatment Of Radiation Injuries In Gynecological Neoplasms

Discover the hyperbaric medicine center opened in our clinic. Centrokinetic has the top-performing hyperbaric chamber in Bucharest, with multiple medical and anti-aging uses. The Baroks chamber has 5 seats, and operates at a constant pressure of 2.5 atmospheres, being fully automated and having protocols for each condition, and can be used individually for each patient. 

Hyperbaric oxygen therapy - benefits

Patients who use the clinic's hyperbaric therapy services benefit from:

• The only medically accredited hyperbaric therapy chamber in Bucharest, which operates at 2.5 atmospheres (those for aesthetic use go to 1 atmosphere and have no medical benefits).
• A safe medical procedure, without irradiation, without pain, without other side effects. 
• The specialized medical team consists of recovery doctors, orthopedists, rheumatologists, neurologists, and neurosurgeons, meaning a multidisciplinary team specialized in all diseases that can be treated with hyperbaric therapy. 
• Premium conditions at a fair price. Our clinic is recognized for the conditions offered and for the care of each patient. But we do not need to pay exorbitant prices to have access to quality medical services. At Centrokinetic you can find an affordable and fair price. But note that we do not have a contract with the National Health Insurance House (we do not offer state reimbursed services)

Centrokinetic is keeping contact with prestigious clinics and universities in Belgium, the Netherlands, France, and Greece to constantly update treatments to provide patients with the best medical solutions.

A radionecrotic wound gradually progresses to involve surrounding tissue and frequently results in vesicovaginal, colovaginal, and rectovaginal fistulae, as well as a range of symptoms from vaginitis, deep dyspareunia, frank hematuria, and radiation proctitis to frank ulceration and necrosis. This is a very painful and particularly debilitating condition and associated with a malodorous and serosanguinous discharge. Most patients become socially isolated and are at risk for depression, nutritional deficiency, and require repeated hospitalizations. Medical treatment typically involves topical wound care, and unfortunately, treatment failure is common. Surgical repairs of fistulae related to radiation necrosis are not only technically difficult, but even the use of skin and myocutaneous flaps have met with only limited success due to a compromised blood supply. However, hyperbaric oxygen therapy (HBOT) is a treatment modality that can repair radiation-induced vascular changes. 

Transcutaneous oxygen measurements four years after HBOT have revealed near-normal levels, implying that the angiogenesis is essentially permanent. HBOT is the first available treatment for delayed radiation injuries that is potentially disease-modifying and is associated with healing in ulcerated, necrotic tissues. In April 2005, the Undersea and Hyperbaric Medical Society approved HBOT as an effective treatment for delayed radiation injury. That same year, the Food and Drug Administration (U.S.) also approved hyperbaric oxygen therapy for the treatment of delayed radiation injury (soft tissue and bony necrosis). The mechanism by which HBOT is thought to treat radiation tissue injury is via the induction of neovascularization, thereby reversing tissue hypoxia. The stimulus for angiogenesis appears to be mediated through macrophages responding to the oxygen gradient between the damaged hypoxic cells and the normal tissue surrounding them.

Other biochemical pathways involved include stem cell mobilization from bone marrow and vasculogenesis, resulting in elevated vascular endothelial growth factor levels. The subacute and chronic phases of radiation wounds are particularly suited to this form of therapy. HBOT acts to stimulate collagen formation at the wound edges through elevation of local tissue oxygen tension. New microvasculature which is dependent on a collagen matrix is greatly enhanced in this setting and allows re-epithelization to occur. HBOT also stimulates fibroblast proliferation. Typically, the treatment protocol for HBOT in patients with radiation-induced pelvic soft tissue injury and in whom the lesion is likely to remain chronic or deteriorate further, often consists of once-daily treatments at 2.5 atmospheres absolute pressure (ATA) on a five-days-per-week basis for up to 40 treatments, depending upon the patient’s condition. Follow-up should be conducted at four weeks. For the treatment and prevention of osteoradionecrosis, a protocol by Marx, et al. consists of 20 HBOT sessions before surgery in a previously irradiated area and 10 sessions afterward.

What are the effects of oxygen therapy on the body?

• Decreases inflammation
• Increases the body's oxygen saturation by 20-30%
• Increases the body's immunity
• Increases blood circulation and stimulates the formation of new capillaries
• Decreases toxins in the body
• Stimulates the production of new blood cells
• Increases healing rate

Objective

The study aims to provide recommendations on the use of hyperbaric oxygen therapy in tissue problems caused by radiation for soft tissue necrosis, cystitis, proctitis, bone necrosis, and other complications in women treated with radiation for gynecological cancer.

Strategy

Relevant evidence for this topic was searched in the databases. Search terms include hyperbaric oxygen, therapy or hyperbaric oxygenation; pelvis or pelvis or gynecology; and radiation damage or proctitis or cystitis or lesions the only limitation being the English language. The search identified a total of 45 studies, four of which were clinical trials.

Women who have late tissue damage caused by radiation, including soft tissue necrosis, cystitis, proctitis, osteonecrosis, and other complications, caused by radiation therapy for cervical cancer and malignancies.

HBOT is effective for tissue damage that has been treated with radiation, especially the head, neck, anus, and rectum. Based on the mechanism of action, there is an adequate basis for proposing that HBOT be largely effective in delaying tissue damage with radiation.

The National Cancer Institute's Common Toxicity Classification System (CTC) decreased from an average of 3.3 ± 0.75 before HBOT to 0.3 ± 0.63 after HBOT. Rectal bleeding stopped in five of six patients; proctitis and dysuria were resolved in six of the seven cystitis patients; macroscopic hematuria stopped for seven out of seven patients; scar complications were resolved in two out of two patients, and none reported side effects associated with HBOT. Jones et al. (2006) also reported that in patients with radiation-induced proctitis refractory to standard therapy, HBOT resulted in complete resolution of rectal bleeding in four patients and relief of symptoms in three others.

Although HBOT did not have a significant effect on pain, its effect on tissue damage caused 50% of patients to report a beneficial effect of treatment.

In 2005, Chong and colleagues demonstrated in a retrospective study that for patients with radiation-induced hemorrhagic cystitis (pelvis) who received HBOT at 2.36 atmospheres absolute pressure, 90 minutes a day, for 33 sessions, the effects were was of total or partial resolution of hematuria in 80% of cases (48 out of 60 analyzed); however, this effect was increased in 96% of patients when treatment was initiated within six months of onset. Moreover, clot formation decreased in patients who received HBOT 6 months after onset.

Response rates were 81%, 83%, and 78% for patients who underwent external beam, primary, or adjuvant pelvic radiotherapy. In another retrospective study, Bui et al. (2004) analyzed the side effects of radiation on the pelvis and the effects of HBOT on the disease, finding that the severity of symptoms was improved after treatment with HBOT; 50% of patients reported improvement in tissue necrosis / mucosal side effects; the incidence of recurrence in these patients was 22%.

Regarding the potential risks and side effects associated with the use of HBOT, it is recommended that all patients be evaluated by a physician specializing in hyperbaric therapies. Patients with the following medical conditions should be treated with caution: middle or inner ear disorders, congenital heart disease, claustrophobia, spherocytosis, diabetes, seizures, lung problems, asthma, upper respiratory tract infections, chronic obstructive pulmonary disease, eustachian tube dysfunction, high fever, cataracts, pregnancy or the use of a pacemaker. Also, the following are absolute contraindications to the use of HBOT: untreated pneumothorax and concomitant use of bleomycin, cisplatin, disulfiram, doxorubicin, and sulfamylon.

By applying these principles, serious risks are rare, and more common side effects are mild and easy to manage. The clinical condition (ie pain caused by cystitis, proctitis, bone necrosis, soft tissue necrosis, etc.) for which HBOT is considered a therapeutic option should be quantified and clinical endpoints determined on a case-by-case basis before initiating HBOT treatment. In general, after 20-25 HBOT treatments, it is recommended that a clinical evaluation be performed to reassess the patient's condition and determine if improvements have been made. If no significant progress has been made, there should be a reevaluation to determine if HBOT is an appropriate treatment option.

IN CASE YOU HAVEN'T ALREADY HEARD ABOUT US

Centrokinetic is the place where you will find clear answers and solutions for your motricity problems. The clinic is dedicated to osteoarticular diseases and is divided into the following specialized departments:

• Orthopedics , a department composed of an extremely experienced team of orthopedic doctors, led by Dr. Andrei Ioan Bogdan, primary care physician in orthopedics-traumatology, with surgical activity at Medlife Orthopedic Hospital, specialized in sports traumatology and ankle and foot surgery. .
• Pediatric orthopedics , where children's sports conditions are treated (ligament and meniscus injuries), spinal deformities (scoliosis, kyphosis, hyperlordosis) and those of the feet (hallux valgus, hallux rigidus, equine larynx, flat valgus, hollow foot).
• Neurology , which has an ultra-performing department, where consultations, electroencephalograms (EEG) and electromyography (EMG) are performed. 
• Medical recovery  for adults and  children , department specialized in the recovery of performance athletes, in spinal disorders, in the recovery of children with neurological and traumatic diseases. Our experience is extremely rich, treating over 5000 performance athletes.
• Medical imaging , the clinic being equipped with ultrasound and MRI, high-performance devices dedicated to musculoskeletal disorders, and complemented by an experienced team of radiologists: Dr. Sorin Ghiea and Dr. Cosmin Pantu, specialized in musculoskeletal imaging.