Cade2

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: November 2022
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.



external image sumhorsa.gif

BACK