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Hyperbaric Oxygen Therapy
Delayed Radiation Injuries
HBOT is approved for the treatment of delayed radiation injuries.
Osteoradionecrosis is an area that is non-healing, in which bone has died due to radiation exposure. It's a complication of radiation therapy for cancer in the head or neck. Symptoms include pain, swelling, and sores.
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Soft tissue radionecrosis occurs when radiation exposure kills the soft tissues, causing them to be unable to regenerate normally. Common sites of soft tissue radionecrosis are the head and neck, breast or chest wall, and pelvic organs such as the bladder and rectum.
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Radiation Cystitis is a side effect of radiation treatment to the pelvis (prostate, cervical, bladder, etc.) that causes inflammation and irritation to the bladder, decreasing the blood supply, and causing damage to the cells.
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Radiation Proctitis is a side effect of radiation treatment to the pelvis (prostate, cervical, bladder, etc.) that causes inflammation and irritation to the rectum decreasing the blood supply and causing destruction to the cells.
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How HBOT helps radiation injuries:
HBOT increases and stabilizes oxygen levels within the tissues and creates an environment for healing. This creates the formation of new capillary beds and granulation tissue that assist with wound healing.
It is also helpful in reducing edema that can be caused by infection or surgery. This will provide symptom relief and allow for healing.
Studies on Radiation Injury and HBOT
Outcomes of Radiation Injuries Using Hyperbaric Oxygen Therapy
An Observational Cohort Study
Niezgoda, Jeffrey A. MD, FACHM, MAPWCA, CHWS; Serena, Thomas E. MD, FACS, FACHM, MAPWCA; Carter, Marissa J. PhD, MAPWCA. Outcomes of Radiation Injuries Using Hyperbaric Oxygen Therapy: An Observational Cohort Study. Advances in Skin & Wound Care 29(1):p 12-19, January 2016. | DOI: 10.1097/01.ASW.0000473679.29537.c0
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BACKGROUND
The late effects of radiation therapy following the treatment of cancer are a well-known consequence. Evidence increasingly supports the use of hyperbaric oxygen (HBO) as an adjunctive treatment in a variety of radiation injuries.
RESULTS
A total of 2538 patient entries with 10 types of radiation injuries were analyzed. The 5 most common injuries were osteoradionecrosis (33.4%), dermal soft tissue radionecrosis (27.5%), radiation cystitis (18.6%), radiation proctitis (9.2%), and laryngeal radionecrosis (4.8%). Clinical outcomes following HBOT were positive with symptoms that improved or resolved varying from 76.7% to 92.6%, depending on injury type. Overall, although the mean symptom improvement score between some groups is statistically significant, the differences are probably not clinically meaningful. Patients with osteoradionecrosis had the highest mean symptom improvement score (3.24) compared with a mean of 3.04 for laryngeal radionecrosis.
CONCLUSIONS
Outcomes from a large patient registry of radiation-induced injuries support the continued therapeutic use of HBOT for radiation injuries.
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Korambayil PM, Ambookan PV, Pillai S, Karangath RR, George D. Indian J Surg Oncol. 2020 Sep;11(3):469-474. doi: 10.1007/s13193-020-01128-0. Epub 2020 Jun 15. PMID: 33013130; PMCID: PMC7501368.
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Abstract
To study the effectiveness of hyperbaric medicine in osteoradionecrosis and irradiation induced wounds. To evolve a protocol for management with combined surgical modality for irradiation induced injury. This study was carried out in the Plastic Surgery Department, from November 2011 to December 2018. A total of 30 patients with post irradiation patients subjected to hyperbaric oxygen therapy during the management were enrolled in the study. The results regarding the changes in wound and complications were noted. Out of 30 patients, 20 patients were with radiation injury involving the oral cavity, one patient with left lower limb, one with breast, 3 with radiation injury of cheek, 3 of mandible, one with radiation cystitis and one involving the tooth socket. One patient experienced reversible myopia as a complication of hyperbaric therapy. No other complications were noted. Hyperbaric therapy is a useful adjunct for surgery in management of osteoradionecrosis and post irradiation wound and proves therapeutic in some post irradiated wound where we cannot offer surgical correction.
Radiation-induced cystitis treated with hyperbaric oxygen
therapy (RICH-ART): a randomised, controlled, phase 2–3 trial
Nicklas Oscarsson, Bernd Müller, Anders Rosén, Pär Lodding, Johan Mölne, Daniel Giglio, Karin M Hjelle, Guro Vaagbø, Ole Hyldegaard, Michael Vangedal, Lisbeth Salling, Anders Kjellberg, Folke Lind, Otto Ettala, Olli Arola, Helén Seeman-Lodding
Lancet Oncol 2019; 20: 1602–14, Published Online
September 16, 2019
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Background
Late radiation cystitis is an adverse effect of cancer treatment with radiotherapy in the pelvic region. Symptoms of late radiation cystitis can be assessed with the Expanded Prostate Index Composite Score (EPIC). Previous reports indicate that hyperbaric oxygen therapy reduces symptoms from late radiation cystitis, but the evidence is predominantly based on non-randomised and retrospective studies. We aimed to assess whether hyperbaric oxygen therapy would mitigate symptoms of late radiation cystitis.
Interpretation
Our results suggest that hyperbaric oxygen therapy relieves symptoms of late radiation cystitis. We conclude that hyperbaric oxygen therapy is a safe and well-tolerated treatment.
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Rachel Moses, MD1, Eileen Brandes, MD1, Kevin Krughoff, MD1, Devin Cowan, BS2, Nicole Harlan, MD1, Judy Rees, PhD,MPH3, William Bihrle, III, MD1, Jay Buckey, Jr., MD3.
1Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 2Dartmouth College, Hanover, NH, USA, 3Dartmouth Geisel School of Medicine, Hanover, NH, USA.
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BACKGROUND
Prior studies evaluating hyperbaric oxygen therapy (HBOT) have demonstrated reduced bladder bleeding interventions, however, few U.S. studies have evaluated HBOT’s association with patient-reported outcome measures (PROMs). The purpose of this study is to evaluate the feasibility of collecting PROMs of patient-reported hematuria events and bladder symptoms before and after HBOT through a multi-institutional registry.
CONCLUSIONS
In a novel, multi-institutional prospective data set, we demonstrate the feasibility of collecting PROMs in patients undergoing HBOT. HBOT reduced patient-reported hematuria events significantly but did not consistently reduce UDI scores in the small sample of patients with complete UDI data. Continued expansion of the registry may provide more generalizable results and allow for analysis of factors leading to improved or worsening UDI scores.
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Hyperbaric oxygen as an adjunctive therapy in treatment of malignancies, including brain tumours
Stępień K, Ostrowski RP, Matyja E. Hyperbaric oxygen as an adjunctive therapy in treatment of malignancies, including brain tumours. Med Oncol. 2016 Sep;33(9):101. doi: 10.1007/s12032-016-0814-0. Epub 2016 Aug 2. PMID: 27485098; PMCID: PMC4971045.
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Abstract
Hyperbaric oxygen (HBO) therapy is widely used as an adjunctive treatment for various pathological states, predominantly related to hypoxic and/or ischaemic conditions. It also holds promise as an approach to overcoming the problem of oxygen deficiency in the poorly oxygenated regions of the neoplastic tissue. Occurrence of local hypoxia within the central areas of solid tumours is one of the major issues contributing to ineffective medical treatment. However, in anti-cancer therapy, HBO alone gives a limited curative effect and is typically not applied by itself. More often, HBO is used as an adjuvant treatment along with other therapeutic modalities, such as radio- and chemotherapy. This review outlines the existing data regarding the medical use of HBO in cancer treatment, with a particular focus on the use of HBO in the treatment of brain tumours. We conclude that the administration of HBO can provide many clinical benefits in the treatment of tumours, including management of highly malignant gliomas. Applied immediately before irradiation, it is safe and well tolerated by patients, causing rare and limited side effects. The results obtained with a combination of HBO/radiotherapy protocol proved to be especially favourable compared to radiation treatment alone. HBO can also increase the cytostatic effect of certain drugs, which may render standard chemotherapy more effective. The currently available data support the legitimacy of conducting further research on the use of HBO in the treatment of malignancies.