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.
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