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:

Time to Outcome
Control Rate
HBO Rate
Relative survival reduction
Absolute survival reduction
1 year
95% CI

-18% to 20%
-0.11 to 0.13
NNH= 8 to INF NNT= 9 to INF
5 years
95% CI

-25% to 44%
-0.09 to 0.15
NNH = 7 to INF NNT = 12 to INF

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: November 2022
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.

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