THE EFFECTIVENESS OF HYPERBARIC OXYGEN-AUGMENTED PHYSIOTHERAPY FOR RADIOTHERAPY-INDUCED PELVIC FIBROSIS

Abstract

Background

Radiotherapy-induced pelvic fibrosis is a disabling late complication of pelvic cancer treatment, frequently associated with chronic pelvic pain, reduced mobility, tissue stiffness, and substantial quality-of-life impairment. Conventional physiotherapy can improve function, yet its effectiveness is often constrained by radiation-related hypoxia and impaired tissue repair. Hyperbaric oxygen therapy (HBOT) increases oxygen delivery to hypoxic tissues and may enhance collagen remodeling and microvascular recovery, potentially amplifying physiotherapy outcomes. Evidence on combined HBOT-augmented physiotherapy for pelvic fibrosis remains limited, particularly in South Asian tertiary care settings.

Objective

To determine whether HBOT combined with structured physiotherapy produces superior improvements in pain, range of motion (ROM), fibrosis severity, and quality of life compared with physiotherapy alone in patients with radiotherapy-induced pelvic fibrosis.

Methods

A single-center, parallel-group randomized controlled trial was conducted at a tertiary care hospital in Islamabad, Pakistan. Sixty adults with clinically diagnosed radiotherapy-induced pelvic fibrosis were randomized (1:1) to receive either HBOT plus physiotherapy (n=30) or physiotherapy alone (n=30) for 8 weeks. Physiotherapy sessions were delivered three times weekly, including myofascial release, pelvic mobility training, pelvic floor rehabilitation, functional strengthening, and home exercise guidance. The intervention group additionally received HBOT five days weekly (2.0–2.4 ATA, 100% oxygen, 90 minutes/session; total 40 sessions). Outcomes were assessed at baseline and week 8 using: Visual Analog Scale (VAS) for pain, Modified Pelvic Fibrosis Scale (MPFS) for fibrosis severity, goniometric ROM measures summarized as a composite ROM score, and EQ-5D index for health-related quality of life. Intra-group changes were analyzed with paired t-tests and inter-group differences with independent t-tests (α=0.05).

Results

Baseline characteristics were comparable between groups. After 8 weeks, the HBOT + physiotherapy group demonstrated significantly greater improvements across all outcomes than physiotherapy alone. Mean VAS pain decreased from 7.8 ± 1.0 to 3.4 ± 1.2 (Δ = −4.4), compared with 7.6 ± 1.1 to 5.8 ± 1.3 in controls (Δ = −1.8). ROM composite score increased from 62.0% ± 9.5 to 73.2% ± 9.1 (Δ = +11.2) versus 61.5% ± 10.0 to 66.0% ± 9.8 (Δ = +4.5). Fibrosis severity (MPFS) reduced from 68.0 ± 10.8 to 44.2 ± 11.2 (Δ = −23.8; ~35% improvement), compared with 66.5 ± 11.5 to 58.3 ± 12.0 in the physiotherapy-only group (Δ = −8.2). EQ-5D quality-of-life scores improved from 0.46 ± 0.10 to 0.71 ± 0.11 (Δ = +0.25), compared with 0.47 ± 0.09 to 0.56 ± 0.10 (Δ = +0.09) in controls. The combined therapy was well tolerated, with no serious adverse events requiring withdrawal.

Conclusion

HBOT combined with structured physiotherapy produced substantially superior clinical outcomes to physiotherapy alone for radiotherapy-induced pelvic fibrosis, delivering meaningful pain relief, increased mobility, reduced fibrosis severity, and improved quality of life. These findings support integrating HBOT into pelvic oncology rehabilitation pathways, particularly for patients with severe fibrosis and persistent functional limitations.

Trial Significance

This study provides actionable evidence for a multidisciplinary, tissue-repair–enhanced rehabilitation model for radiation-related pelvic fibrosis in a tertiary care setting in Pakistan