Hyperbaric
oxygenation did not improve survival of patients with carcinoma of the urinary
bladder treated with radiotherapy.
Clinical Bottom Line:
1.
There was no survival advantage by the conduct of radiotherapy while in
hyperbaric oxygen environment.
Appraised
by: Mike Bennett, Dept. of Diving and
Hyperbaric Oxygen, Prince of Wales Hospital, Sydney; Tuesday, 05 January, 1999
Clinical
Scenario:
A patient with carcinoma of the urinary bladder considered suitable for
attempted cure by radiotherapy.
Three-part
Question: In treatment of bladder
carcinoma with radiotherapy, does administration of hyperbaric oxygen during
irradiation confer any benefit in terms of survival?
Search
Terms: Hyperbaric oxygenation,
radiotherapy, bladder neoplasms
The
Study:
Non-blinded concealed randomised
controlled trial without intention-to-treat.
Patients under 75 years with
carcinoma of the urinary bladder without local spread to rectum or vagina and
with lymphatic spread to external iliac nodes only.
Control group (N = 118; 118
analysed): Standard radiotherapy regime for each centre and grade of tumour.
Experimental group (N = 118; 118
analysed): As above, but radiotherapy while at 3ATA.
The
Evidence:
|
Outcome |
Time to
Outcome |
Control
Rate |
HBO Rate |
Relative
survival reduction |
Absolute
survival reduction |
NNH |
|
survival |
1 year |
0.644 |
0.636 |
1% |
0.01 |
125 |
|
95% CI |
|
|
|
-18% to 20% |
-0.11 to 0.13 |
NNH= 8 to INF
NNT= 9 to INF |
|
Survival |
5 years |
0.347 |
0.314 |
10% |
0.033 |
30 |
|
95% CI |
|
|
|
-25% to 44% |
-0.09 to 0.15 |
NNH = 7 to INF
NNT = 12 to INF |
Comments:
1. No standardisation of
radiotherapy regime.
2. No suggestion of better
survival for any stage or treatment regime with oxygen.
3. Cumulative radiation effect
correlated with the incidence of high-dose complications.
Expiry date: January 2004
References:
1.
Cade IS, Dische S, Watson ER,
Wiernik G, Sutherland I. Hyperbaric oxygen and radiotherapy: a medical research
council trial in carcinoma of the bladder. British Journal of Radiology 1978;
51:876-878.
2.
Kirk J, Wingate G, Watson E.
High-dose effects in the treatment of carcinoma of the bladder under air and
hyperbaric oxygen conditions. Clinical Radiology 1976; 27:137-144.
3.
Dische S. The hyperbaric oxygen
chamber in the radiotherapy of carcinoma of the bladder. British Journal of
Radiology 1973; 46:13-17.
4.
Wiernik G, Perrins D. Hyperbaric
oxygen and radiotherapy in advanced carcinoma of the cervix and bladder. Fifth
International Hyperbaric Congress Proceedings II 1974:820-829.
