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World J Gastroenterol. Jul 21, 2021; 27(27): 4413-4428
Published online Jul 21, 2021. doi: 10.3748/wjg.v27.i27.4413
Hyperbaric oxygen therapy as a complementary treatment for radiation proctitis: Useless or useful? – A literature review
Diogo Alpuim Costa, Carla Espiney Amaro, Ana Nunes, Joana Santos Cardoso, Pedro Modas Daniel, Isabel Rosa, João Vieira Branco
Diogo Alpuim Costa, Department of Haematology and Oncology, CUF Oncologia, Lisboa 1998-018, Portugal
Diogo Alpuim Costa, Joana Santos Cardoso, Pedro Modas Daniel, Isabel Rosa, João Vieira Branco, Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisboa 1649-020, Portugal
Diogo Alpuim Costa, Carla Espiney Amaro, Pedro Modas Daniel, Isabel Rosa, Centro de Investigação Naval (CINAV), Portuguese Navy, Base Naval do Alfeite, Almada 2810-001, Portugal
Diogo Alpuim Costa, NOVA Medical School, Faculdade de Ciências Médicas, Lisboa 1169-056, Portugal
Carla Espiney Amaro, Department of Otorhinolaryngology, Hospital das Forças Armadas (HFAR), Lisboa 1649-020, Portugal
Ana Nunes, Department of Gastroenterology, Hospital das Forças Armadas (HFAR), Lisboa 1649-020, Portugal
Joana Santos Cardoso, Department of Vascular Surgery, Centro Hospitalar Universitário de Lisboa Central, Hospital de Santa Marta, Lisboa 1169-024, Portugal
Pedro Modas Daniel, Department of Intensive Care Unit, Hospital das Forças Armadas (HFAR), Lisboa 1649-020, Portugal
Isabel Rosa, Department of General Surgery, Hospital das Forças Armadas (HFAR), Lisboa 1649-020, Portugal
Author contributions: The present manuscript is the result of original work by the authors; Alpuim Costa D conceived and designed the study; Alpuim Costa D, Amaro CE, and Nunes A performed the acquisition, analysis, and interpretation of the data; Alpuim Costa D, Amaro CE, and Nunes A, Cardoso JS, Daniel PM, Rosa I, and Branco JV performed the writing, review, and/or revision of the manuscript; Nunes A and Branco JV performed the manuscript supervision.
Conflict-of-interest statement: Nothing to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Diogo Alpuim Costa, MD, Medical Assistant, Research Fellow, Department of Haematology and Oncology, CUF Oncologia, R. Mário Botas, Lisboa 1998-018, Portugal. diogoalpuimcosta@gmail.com
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: April 18, 2021
Revised: May 2, 2021
Accepted: June 22, 2021
Article in press: June 22, 2021
Published online: July 21, 2021
Processing time: 143 Days and 18.3 Hours
Abstract

Radiotherapy (RT) is the backbone of multimodality treatment of more than half of cancer cases. Despite new modern RT techniques, late complications may occur such as radiation proctitis (RP). The natural history of RP is unpredictable. Minor symptoms may resolve spontaneously or require conservative treatment. On the other hand, for similar and uncomplicated clinical contexts, symptoms may persist and can even be refractory to the progressive increase in treatment measures. Over the last decades, an enormous therapeutic armamentarium has been considered in RP, including hyperbaric oxygen therapy (HBOT). Currently, the evidence regarding the impact of HBOT on RP and its benefits is conflicting. Additional prospective and randomised studies are necessary to validate HBOT’s effectiveness in the ‘real world’ clinical practice. This article reviewed the relevant literature on pathophysiology, clinical presentation, different classifications and discuss RP management including a proposal for a therapeutic algorithm with a focus on HBOT.

Keywords: Radiation proctitis; Radiation proctopathy; Radiotherapy; Radio-induced lesion; Late radiation tissue injury; Delayed radiation injury; Late sequelae; Hyperbaric oxygen therapy; Hyperbaric oxygen; Review

Core Tip: Over the last decades, an enormous therapeutic armamentarium has been considered in radiation proctitis (RP) management including hyperbaric oxygen therapy (HBOT). However, evidence regarding the impact of HBOT on RP and its benefits is conflicting. With the lack of consensus to guide the use of HBOT for the treatment of RP, the goal of this review was to synthesise the existing data, analyse results of previous studies, identify gaps in knowledge, and discuss RP’ management including a proposal of a therapeutic algorithm focusing on HBOT.