HORTIS III - Radiation Cystitis

External beam radiotherapy for palliation or cure of pelvic malignancies frequently involves exposure of important non-target organs and structures. The bladder is one such organ. A resulting injury pattern is frequently one of a progressive morbidity, although spontaneous recovery does occur.

Presentation may involve any combination of pain, frequency, cramping, hemorrhage, clotting, bladder wall ulceration, necrosis and fistula. Numerous topical agents have been employed but the lack of a permanent standard suggests that none are sufficiently effective. Laser coagulation is frequently necessary. Sadly, many go on to cystectomy.

Numerous reports indicate a beneficial role of hyperbaric oxygen, particularly in more advanced states. Supportive clinical evidence is encouraging (Level II B), which is a high a level of evidence as any other intervention short of cystectomy. Still, the use of hyperbaric oxygen therapy is not universally accepted. HORTIS III will further investigate hyperbaric medicine’s therapeutic role in this particularly challenging condition.