TLDR

• Late radiation cystitis after pelvic cancer radiotherapy can cause blood in the urine, urgency, frequency, incontinence, pain, and a life built around bathroom access.
• RICH-ART is a multicentre randomised phase 2-3 trial published in The Lancet Oncology (2019). Patients randomised to hyperbaric oxygen (HBOT) improved more on the EPIC urinary total score than those on standard care at about six to eight months: +17.8 vs +7.7 points (difference 10.1, P = 0.013).
• The 2025 long-term follow-up in eClinicalMedicine found mean EPIC urinary improvement after HBOT held at about +19 points at five years. Among early responders (≥9-point gain), the mean increase at five years was 22.9 points.
• Delayed radiation injury of soft tissue and bone is a UHMS-recognized indication category. Coverage still depends on documentation, plan rules, and authorization.
• OxygenWell delivers medical-grade HBOT up to 2.4 ATA in grounded monoplace chambers in Sherman Oaks and Calabasas, open 7 days, with billing support for qualifying insurance and referral pathways.

Table of Contents

• What is late radiation cystitis?
• What was RICH-ART designed to answer?
• 2019 primary results: EPIC urinary scores
• 2025 five-year follow-up: did the benefit last?
• How RICH-ART dosed HBOT
• What this means for patients and referring clinicians
• How OxygenWell approaches radiation cystitis
• FAQs
• Next step

What is late radiation cystitis?

Pelvic radiotherapy for prostate, cervical, rectal, uterine, and related cancers can injure bladder tissue months or years later. Chronic radiation-induced cystitis is often described in about 5-10% of pelvic radiotherapy patients. Symptoms may include haematuria (blood in the urine), urgency, frequency, incontinence, dysuria, and pain. For some people the problem is socially disabling: plans revolve around toilet access, sleep breaks, and bleeding episodes.

This is a form of delayed radiation injury. Soft tissue and bony necrosis after radiation sit in a UHMS-recognized indication category for hyperbaric oxygen when documentation supports medical necessity. For bladder-focused clinical context on our site, see radiation cystitis and HBOT and our broader guide to HBOT around radiation therapy.

What was RICH-ART designed to answer?

RICH-ART stands for Radiation-Induced Cystitis treated with Hyperbaric oxygen – A Randomised controlled Trial. It was an open-label, multicentre phase 2-3 study at five Nordic university hospitals (Sahlgrenska and Karolinska in Sweden, Haukeland in Norway, Rigshospitalet in Denmark, Turku in Finland).

Who was enrolled (high level) Adults 18-80 with chronic radiation-induced cystitis after pelvic radiotherapy completed at least six months earlier, and an EPIC urology score below 80. Cancer Network’s summary of the 2019 paper notes most participants had prostate cancer, with a substantial cervical cancer group and smaller numbers of other pelvic malignancies. Median time from radiotherapy to inclusion was just over four years; symptoms had often been present for years already.

What was compared

• HBOT arm: 30-40 sessions, 100% oxygen at about 240-250 kPa (roughly 2.4-2.5 ATA), 80-90 minutes daily.
• Control: standard of care, without restrictions on other meds or interventions.

The primary endpoint was change in the EPIC urinary total score from baseline to about six months. After the primary window, control patients could be offered HBOT. That design is important when you read the five-year paper: long-term data focus on people who actually received HBOT.

Primary report: Oscarsson et al., Lancet Oncology 2019 (PubMed; Lancet Oncology abstract). Accessible summary of the 2019 results: Cancer Network.

2019 primary results: EPIC urinary scores

In the intent-to-treat population of 79 patients with late radiation cystitis symptoms (41 HBOT, 38 standard care after early withdrawals from the randomised set of 87):

Cancer Network’s report of the trial also notes greater improvement on EPIC bother and incontinence subscores, bowel scores, and SF-36 general health with HBOT versus standard care. Ear and vision symptoms related to pressure/oxygen were the main adverse events clearly linked to treatment in the HBOT arm.

These numbers match what many patients and urologists care about: not a lab curiosity, but measurable change on a validated urinary symptom instrument after years of bladder problems.

2025 five-year follow-up: did the benefit last?

The long-term paper asks whether HBOT gains hold when chronic radiation injury is expected to stay the same or worsen over years.

Published: Oscarsson et al., eClinicalMedicine 2025 (RICH-ART long-term follow-up) (PubMed; full text). University of Gothenburg summary: ScienceDaily, April 23, 2025.

Key findings from the follow-up abstract and report:

• Of patients who completed the early study path and were eligible for long-term tracking, 70 adults contributed follow-up analyses.
• Mean EPIC urinary total score improved 18.0 points (95% CI 14.2-21.8) from 46.6 pre-HBOT to 64.6 at six months.
• At year 5, mean improvement remained 19.1 points (95% CI 13.3-24.9).
• Responders (n = 48; 68.6%), defined as ≥9-point improvement after HBOT, kept a mean increase of 22.9 points (95% CI 16.2-29.6; p < 0.0001) at 5 years.
• Non-responders (n = 22; 31.4%) showed no early benefit (43.5 [SD 15.6] to 44.6 [SD 16.6]).
• Nine of the 70 patients (12.8%) received additional HBOT for recurring symptoms.

Principal investigator Nicklas Oscarsson, quoted in the University of Gothenburg release, described responders moving from severe, toilet-bound limitation toward a more normal life, with improvement lasting at least five years in this follow-up window. The authors interpret the data as support for HBOT as a durable option for chronic radiation-induced cystitis, while calling for more work on optimal protocols, biomarkers, and health economics.

How RICH-ART dosed HBOT

That pressure band sits in the medical-grade range used for many radiation-injury protocols. Mild “wellness” enclosures at much lower ATA do not reproduce this trial dose. OxygenWell’s monoplace chambers are rated up to 2.4 ATA with 100% medical-grade oxygen by non-rebreather mask, which aligns with the clinical pressure class used in RICH-ART and related radiation protocols.

Related reading: soft tissue radionecrosis (STNR), Marx Protocol for osteoradionecrosis of the jaw, and insurance overview.

What this means for patients and referring clinicians

For patients If pelvic radiation left you with chronic bladder symptoms years later, randomised evidence now covers both short-term superiority of HBOT over usual care on EPIC urinary scores and multi-year stability of those gains after a full course. That does not mean every person responds. About one in three in the long-term cohort were non-responders by the ≥9-point rule. A consult is still the right next step, not a self-start course.

For urology, oncology, and radiation oncology RICH-ART is one of the stronger prospective datasets in this niche: multicentre, randomised primary phase, then systematic five-year follow-up after HBOT. Standard care remains part of the pathway (meds, procedures, physio as indicated). HBOT is an adjunct aimed at tissue biology: better oxygenation, angiogenesis support, and quieter chronic inflammation in irradiated bladder tissue, as the Gothenburg team describes.

For VA and insurance pathways Delayed radiation injury pathways may be covered when medically eligible and authorized. OxygenWell does not decide payer eligibility. We help assemble records and pursue pre-authorization when the case fits covered indication language. Veterans: see VA Community Care HBOT in Los Angeles.

How OxygenWell approaches radiation cystitis

• Medical-grade dose: monoplace chambers, 100% oxygen, pressures up to 2.4 ATA, sessions typically in the ~90-minute oxygen-time class used in many radiation protocols.
• Two Los Angeles locations, 7 days: Sherman Oaks (Galleria) and Calabasas, with evening capacity that helps 30-40 session courses finish without multi-month gaps.
• Team: Certified Hyperbaric Technicians (many EMT-certified); PA on site most weekday hours; billing partners for qualifying pre-auth.
• Coordination: We work from radiation history, urology notes, cystoscopy or imaging when available, and the referring plan.
• Leadership context: Dr. Beth Meneley, DAOM, L.Ac., brings 25+ years in integrative medicine and 12+ years dedicated to hyperbaric medicine in Los Angeles; the clinical team has supervised 50,000+ HBOT sessions.

HBOT does not replace oncology or urology care. It supports healing biology in tissue that radiation has left hypoxic and fibrotic.

FAQs

Is RICH-ART only about prostate cancer?

No. Prostate cancer was the largest group, but cervical and other pelvic cancers were included. The EPIC urinary domain was used as a symptom score across that mixed population.

How soon after radiation can HBOT start for cystitis?

RICH-ART required pelvic radiotherapy finished at least six months earlier (chronic / late injury setting). Acute radiation side effects are a different clinical question. Timing for any individual case belongs with the treating team.

How many sessions did the trial use?

30-40 daily sessions at ~2.4-2.5 ATA for 80-90 minutes of oxygen breathing. Your prescription may differ based on severity, response, and authorization.

Will my insurance cover HBOT for radiation cystitis?

Often possible when documentation supports a delayed radiation injury / soft tissue pathway and the plan authorizes care. Coverage is never automatic. Call us at (818) 661-0939 to start a records review, or see oxygenwell.com/insurance.

What if symptoms return years later?

In the five-year RICH-ART follow-up, a minority (~13%) received additional HBOT for recurrence. That is a clinical decision, not a fixed package.

Next step

If late radiation cystitis is limiting your life after pelvic cancer treatment, bring your radiation summary and urology notes. We will map whether a RICH-ART-style course is appropriate, what documentation payers need, and how to schedule across Sherman Oaks or Calabasas.

Call (818) 661-0939 or request a visit at oxygenwell.com/contact.
Locations: Sherman Oaks and Calabasas · open 7 days · www.oxygenwell.com

Sources

1. Oscarsson N, et al. Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2-3 trial. Lancet Oncol. 2019. PubMed · Lancet Oncology
2. Oscarsson N, et al. RICH-ART long-term follow-up. eClinicalMedicine. 2025. PubMed · Full text
3. Cancer Network summary of 2019 results (EPIC +17.8 vs +7.7). cancernetwork.com
4. University of Gothenburg / ScienceDaily on five-year durability (April 23, 2025). sciencedaily.com