Hi Dr. Jacques,

Thank you for your question.

The UHMS soft tissue radiation necrosis (which includes radiation cystitis) treatment protocol typically recommends 20 treatments as the minimum and 60 treatments as the maximum, with the average course being 40 treatments. The treatments are once daily and are consecutive typically Monday through Friday. If the number of treatments exceeds 40, a utilization review is suggested.

Since your patient did not complete the full 60 treatments previously, an additional 20 treatments could be considered, followed by an assessment of her response. At that point, evaluation whether insurance will authorize further treatments would be warranted.

I do have some questions regarding her initial HBOT course 8 years ago that may help guide your HBOT decision:

1. Why were treatments stopped after 40 sessions during her initial treatment course?

2. Did her symptoms resolve after those 40 treatments, or was treatment discontinued due to a lack of improvement?

3. Has she been experiencing the same symptoms for the past 8 years, or has there been a recent change or worsening in her condition?

If her symptoms have changed or worsened recently and this is a new problem, it may be appropriate to initiate a new course of HBOT, potentially up to the maximum of 60 treatments, depending on her response. This would be assessed based on a combination of factors such as pain, hematuria, incontinence, frequency of self-catheterization, and any cystoscopy findings. 

Ultimately, the decision to proceed with additional HBOT sessions should be tailored to her individual needs and response to treatment within the UHMS treatment threshold guidelines.

Resources:

WoundReference Soft Tissue Radiation Necrosis

Utilization Review

HBOT Threshold Levels

Good evening Kim, sorry for the delay. Thank you for your response.
The patient stopped the HBO treatments 8 years ago, because of logistics/costs, she lived 4 hours away. We are the first clinic here in Sudbury (northern ontario). She reports some definite improvements(but not full resolution) with the therapy, but is now worse, and at a severe level with contracted bladder, bleeding(not severe). I don't believe that she was ever without symptoms. I do feel that we will do 60 for sure, but I am hoping to try and do more. Here in Canada, we don't have the strict insurance criteria like you do, but we have to be able to "justify" what we do. She does get regular cystoscopies (every 4-6mo) for intravesical treatments, so she will be reassessed visually. I read some articles did up to 120 HBO treatments. So, if "insurance" was not an obstacle, and if she reports continuing improvements, how far could we go so as to get closer to a manageable level.