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. 2020 Apr 9:10:390.
doi: 10.3389/fonc.2020.00390. eCollection 2020.

The Effects of Hyperbaric Oxygen Therapy on Pelvic Radiation Induced Gastrointestinal Complications (Rectal Bleeding, Diarrhea, and Pain): A Meta-Analysis

Jun-Hua Yuan  1 , Li-Min Song  1 , Yuan Liu  1 , Man-Wen Li  1 , Qian Lin  1 , Rui Wang  1 , Cai-Shun Zhang  1 , Jing Dong  1   2
Affiliations

The Effects of Hyperbaric Oxygen Therapy on Pelvic Radiation Induced Gastrointestinal Complications (Rectal Bleeding, Diarrhea, and Pain): A Meta-Analysis

Jun-Hua Yuan et al. Front Oncol. .

Abstract

Background: Radiotherapy is a routine treatment for pelvic cancer patients. While it had been proven effective, gastrointestinal side effects remain a concern, impairing the quality of life. A few studies focused on the effects of hyperbaric oxygen (HBO) treatment to alleviate radiation-induced gastrointestinal complications. This meta-analysis aimed to critically review and summarize existing literature, assessing the effectiveness of HBO therapy for the treatment of radiation-induced gastrointestinal side effects. Methods: Medical literature search was performed with PubMed, Cochrane Library, and EMBASE up to March 14, 2019. Literatures about HBO treatment upon patients undergoing pelvic cancer (endometrial, cervix, rectum, or prostate cancers) radiotherapy were collected, and the effects of HBO treatment on radiotherapy-induced gastrointestinal complications were evaluated. A random-effects model was used to calculate the pooled effect size. Subgroup analyses were performed to search for sources of heterogeneity. Publication bias was detected with Funnel plots and Egger's test. Results: Three different radiotherapy-related gastrointestinal complications, including rectal bleeding, diarrhea, and pain, were analyzed after screening. It was revealed that the improvement rates were considerable in rectal bleeding (0.81, 95% CI: 0.74-0.89) and diarrhea (0.75, 95% CI: 0.61-0.90) and slightly in pain (0.58, 95% CI: 0.38-0.79). Subgroup analysis revealed factors that significantly influenced the heterogeneity of rectal bleeding, diarrhea, and pain (evaluation criteria, follow-up time, and scoring system, respectively). No significant publication bias was detected. Conclusion: HBO treatment might have the potential to alleviate radiotherapy-related gastrointestinal complications, including rectal bleeding, diarrhea, and pain, but more data are needed for further conclusions. Other symptoms were not further analyzed, as the number of studies was insufficient. More large-scale and prospective studies are needed for better evaluation of HBO's therapeutic values.

Keywords: diarrhea; hyperbaric oxygen; pain; pelvic radiotherapy; rectal bleeding.

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Figures

Figure 1
Figure 1
Flow chart of literature search.
Figure 2
Figure 2
Forest plot of rectal bleeding.
Figure 3
Figure 3
The funnel plot of the publication bias of rectal bleeding.
Figure 4
Figure 4
Forest plot of rectal bleeding based on evaluation criteria for symptom improvement.
Figure 5
Figure 5
Forest plot of diarrhea.
Figure 6
Figure 6
The funnel plot of the publication bias of diarrhea.
Figure 7
Figure 7
Forest plot of diarrhea based on follow-up time.
Figure 8
Figure 8
Forest plot of pain.
Figure 9
Figure 9
The funnel plot of the publication bias of pain.
Figure 10
Figure 10
Forest plot of pain based on the scoring system.
See this image and copyright information in PMC

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