ABSTRACT

Eckert KA, Fife CE, Carter MJ. Systematic Review of Hyperbaric Oxygen for Late Radiation Tissue Injury (Bowel, Bladder). Undersea Hyperb Med. 2025 Third Quarter; 52(3):313-325.

Background: This systematic review evaluated comparative studies to determine if hyperbaric oxygen therapy (HBO2) is beneficial to late radiation tissue injury (LRTI) of the bowel/bladder.

Methods: We included adequately powered, comparative studies evaluating the effect of HBO2 on patients with LRTI (≥3 months duration and/or ≥6 months after radiation therapy) to the bowel/bladder compared to no HBO2 or placebo/sham; complete outcomes data must have corresponded to the tools used to measure change in LRTI symptoms. Medline was searched through May 4, 2023, Embase through May 29, 2023, and Google Scholar through May 5, 2023. The Cochrane risk-of-bias tool and GRADE approach were used with a certainty of outcomes assessment.

Results: Three RCTs were included with 273 subjects. Two double-blinded studies evaluated rectal symptoms; one open study evaluated cystitis. One study had a low risk of bias; two had some concerns. All had moderate certainty of outcomes. There is moderate certainty with a weak recommendation for using HBO2 for rectal complications or cystitis, which (in context of GRADE terminology) means the decision to treat depends on a case-by-case basis.

Discussion: The highly heterogeneous design of the trials made meta-analysis impossible, but moderate certainty of the beneficial effect of HBO2 on LRTI to the rectum and bladder was confirmed. With the weak recommendation, a discussion should take place between the patient and their physician as to whether or not the patient is likely to benefit from HBO2.

Keywords: cancer; chronic wounds; comparative studies; cystitis; hyperbaric oxygen therapy; LRTI; proctitis