Şefika KÖRPINAR, Yavuz DİZDAR, Maide ÇİMŞİT, Kaytan Esra SAĞLAM, Rıdvan AVUL, Yaman Fulya AĞAOĞLU, Binnur PINARBAŞI

Kronik radyasyon proktiti tedavisinde hiperbarik oksijenizasyon; dört yıllık deneyimin retrospektif analizi

AMAÇ Malign tümörlerin tedavisinde önemli bir yeri olan radyoterapi, aylar/yıllar içinde ortaya çıkan, yol açtığı ciddi yapısal ve fonksiyonel bozukluklar nedeniyle yıkıcı bir seyir izleyebilen, tedavisi güç geç dönem komplikasyonlarına neden olabilir. Radyasyon proktiti pelvik radyoterapi sonrası gelişebilecek komplikasyonlardan biridir. Bu çalışmada konvansiyonel tedavi yöntemlerine dirençli kronik radyasyon proktitli hastalarda hiperbarik oksijen tedavisi (HBO) ile elde edilen sonuçlar bildirilmiştir.GEREÇ VE YÖNTEM Standart medikal tedavi yöntemlerine dirençli kronik radyasyon proktiti tanısıyla Kasım 2001-Aralık 2005 tarihleri arasında merkezimize refere edilen 29 hastanın (16 kadın, 13 erkek; ort. yaş 65; dağılım 45-78) tıbbi kayıtları incelendi, kohort karakteristikleri, kanser dışı sistemik hastalık, tütün ve alkol kullanımı, tanı, önceki tedavi metodları ve HBO ile elde edilen sonuçlar saptandı.BULGULAR Çalışmamızda planlanan tedavi süresini tamamlayan 18 hastanın %88'inde tedaviye tam ya da parsiyel yanıt alındı. Belirgin iyileşme özellikle kanama, ağrı ve diyare nedeniyle başvuran hastalarda görüldü. Ancak tenezm, inkontinans gibi yaşam kalitesini önemli ölçüde etkileyen fonksiyonel bozukluklarda da anlamlı düzeyde gerileme kaydedildi.SONUÇ Randomize, kontrollü, çok merkezli yayınlar bulunmamakla birlikte bu retrospektif çalışmanın ve literatürdeki diğer yayınların da işaret ettiği gibi, HBO, kronik radyasyon proktitinde güvenli ve etkili bir tedavi yöntemi olarak dikkat çekmektedir.

Hyperbaric oxygenation in treatment of chronic radiation proctitis; retrospective analyses of four years experience

OBJECTIVES Radiation therapy is a key component in the control and eradication of malignant tumors. Late radiation tissue injury (LRTI) is a complication of radiotherapy and may occur several months to many years after completing the therapy. LRTI is progressive by its nature, and can be devastating due to the structural and functional abnormalities in affected tissues and organs. Radiation proctitis is a potential complication following pelvic radiation therapy. We report our experience with the use of hyperbaric oxygen treatment (HBO) for chronic radiation proctitis cases resistant to conventional treatments.METHODS During the period November 2001 to December 2005, 29 patients with chronic radiation proctitis, who failed to respond to oral and/or topical conventional treatments, were referred to the Department of Underwater and Hyperbaric Medicine, Istanbul Faculty of Medicine (16 females and 13 males; mean age 65). The clinical data were extracted from the medical records and the characteristics of the patient cohort, medical history, tobacco and alcohol use, diagnosis, previous medical therapies, outcome of HBO were detected.RESULTS In the 88% of the 18 cases who completed planned HBO, complete or partial healing was obtained. Significant improvement was observed in cases whose main complaints were bleeding, pain and diarrhea. Tenesmus and incontinence, which affects the quality of life were also decreased.CONCLUSION Although prospective, randomized, controlled clinical trials are still absent, avaliable retrospective studies, case reports and the present study emphasize that HBO can effectively be used for the treatment of radiation proctitis.

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