Radiation Oncology/Supportive care/Hyperbaric

Hyperbaric Oxygen

Acute RT Toxicity

• Erasmus University Medical Center (2006-2007) -- RT +/- HBO
  • Randomized. Trial stopped prematurely due to slow accrual and lack of financial support. 19 of expected 132 patients, oropharynx or nasopharynx. Standard RT, then Arm 1) HBO vs. Arm 2) control. HBO given in 30 sessions @ 2.5 ATA x 90 minutes, started within 2 days after RT completion
  • 2009 PMID 19386439 -- "Early hyperbaric oxygen therapy for reducing radiotherapy side effects: early results of a randomized trial in oropharyngeal and nasopharyngeal cancer." (Teguh DN, Int J Radiat Oncol Biol Phys. 2009 Nov 1;75(3):711-6. Epub 2009 Apr 20.)
    • Outcome: Significant improvement in QoL for HBO, particularly swallowing, stickly saliva, xerostomia, and pain in mouth
    • Conclusion: HBO after RT results in better quality of life

Osteoradionecrosis

• French Multi-Institutional (1997-2001) -- hyperbaric oxygen vs. placebo
  • Randomized. Stopped early after 2nd interim analysis for lower HBO outcomes. 68 patients, history of RT for H&N cancer, with overt mandibular radionecrosis. Severe forms such as mandibular fracture or bony resorption excluded. Arm 1) 30 HBO exposures @ 2.4 ATM x90 min prior to surgery, with additional 10 HBO exposures post-operatively vs. Arm 2) placebo
  • 2004 PMID 15520052 -- "Hyperbaric oxygen therapy for radionecrosis of the jaw: a randomized, placebo-controlled, double-blind trial from the ORN96 study group." (Annane D, J Clin Oncol. 2004 Dec 15;22(24):4893-900. Epub 2004 Nov 1.)
    • Outcome: 1-year recovery HBO 19% vs. placebo 32% (NS)
    • Conclusion: Patients with overt mandibular osteoradionecrosis didn't benefit from HBO
  • Comment (PMID 16119304): Suboptimal surgery, therefore results not surprising. Principles as follows: 1) Deliver majority of HBO prior to surgery, 2) Eradicate all non-viable bone, 3) Optimize surgical technique. This was not done properly in trial

• University of Miami -- hyperbaric oxygen vs. penicillin
  • Randomized. High risk patients, history of RT >60 Gy to mandible, who required tooth removal, no persistent tumor. Arm 1) hyperbaric oxygen 20 sessions @ 2.4 ATA x90 minutes prior to extraction, followed by 10 additional sessions after vs. Arm 2) penicillin 1 million units
  • 1985 PMID 3897335 -- "Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin." (Marx RE, J Am Dent Assoc. 1985 Jul;111(1):49-54.)
    • Outcome: incidence of ORN: HBO 5% vs. penicillin 30% (SS)
    • Conclusion: HBO should be considered a prophylactic measure when post-RT dental care involving trauma to tissue is necessary