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Radiation Cystitis HBOT — SCE Medical Oncology MCQ

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HardOncological EmergenciesRadiation Cystitis HBOTSCE Medical Oncology

A patient has chronic haemorrhagic cystitis after pelvic radiotherapy. Infection and recurrent tumour have been excluded, cystoscopic coagulation and irrigation have not produced durable control, and bleeding is not immediately life threatening. Which bladder-preserving intervention has randomised evidence of symptom improvement sustained at five years?

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Correct answer: A — A course of hyperbaric oxygen therapy after specialist eligibility assessment

RICH-ART provides randomised evidence that hyperbaric oxygen improves chronic radiation-cystitis symptoms, with benefit sustained at five years; local availability and commissioning still need confirmation. Alum can control haemorrhage but does not have that trial-and-durability evidence. Formalin is a high-morbidity salvage intervention. Arterial embolisation is generally reserved for severe refractory bleeding. Hyaluronic-acid instillation has a different and less robust evidence base.

Reference: RICH-ART five-year follow-up of hyperbaric oxygen for radiation cystitis (Published May 2025): https://pubmed.ncbi.nlm.nih.gov/40291346/; Royal College of Radiologists radiotherapy for cervix cancer (Current UK clinical oncology guidance, accessed July 2026): https://www.rcr.ac.uk/our-services/all-our-publications/clinical-oncology-publications/radiotherapy-for-cervix-cancer/