Article – 1 - Delayed radiation injury to soft tissue and bone (radionecrosis)
Title: Hyperbaric oxygen an adjunctive treatment for delayed radiation injuries of the abdomen and pelvis
Authors: Feldmeier, JJ; Heimbach, RD; Davolt, DA; Court, WS; Stegmann, BJ; Sheffield, PJ
Digital Object Identifier (or PMID etc): PMID: 8989850
Keywords: Nil
Abstract: Radiation therapy is often utilized as adjunctive or primary treatment for malignancies of the abdomen and pelvis. Radiation complications are infrequent, but can be life threatening or significantly diminish the quality of life. Radiation necrosis is an approved indication for hyperbaric oxygen (HBO2). Previous publications have reported results in treating delayed radiation injuries involving many sites. This paper reports the experience of a single physician group in treating delayed injuries of the abdomen and/or pelvis. Forty-four such patients have been treated since 1979. Of the 41 patients available for follow up, 26 have healed; 6 failed to heal; and 9 patients had an inadequate course of therapy (fewer than 20 treatments). Especially encouraging was the resolution of fistulae in six of eight patients with only three requiring surgery for closure.
Conclusion: Overall, the success rate in patients receiving at least 20 HBO2 treatments was 81%. Hyperbaric oxygen is a useful adjunct in treatment of delayed radiation injuries of the pelvis and abdomen.
Article – 2 - Delayed radiation injury to soft tissue and bone (radionecrosis)
Title: Hyperbaric oxygen therapy in the treatment of complications of irradiation in head and neck area.
Authors: Narozny, W; Sicko, Z; Kot, J; Stankiewicz, C; Przewozny, T; Kuczkowski, J
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: We have investigated the treatment results of hyperbaric oxygen (HBO2) to patients with radiation-induced tissue complications. Eight patients (1.4%) from 548 with head and neck cancers treated surgically with post- or preoperative radiotherapy or radiotherapy alone in standard doses who developed postradiation complications (6 patients with laryngeal chondroradionecrosis, 1 patient with osteoradionecrosis of the temporal bone, and 1 patient with soft tissue radionecrosis) are presented. To evaluate radiation reactions occuring in the head and neck region, we used the Chandler grading system for classification of postradiation larynx injuries and SOMA/LENT score for classification of postradiation injuries of mucosa of upper aerodigestive tract. Grades I and II in those grading systems are expected side effects of radiation therapy, thus our cases were all in grades III and IV. The HBO2 was performed after failure of the conventional treatment (antibiotics, steroids, topical therapy). The number of HBO2 expositions was from 8 to 39 and the delay to therapy from 2 to 22 months.
Results: Symptoms resolved in all treated patients. Six patients with laryngeal chondroradionecrosis had no symptoms after therapy and in three of them after partial laryngectomy the decannulation was performed. In one patient with mucosal radionecrosis after total laryngectomy, the esophageal fistula was closed and in one patient with osteoradionecrosis of the temporal bone, wound debridement followed.
Conclusion: The authors' experience supports the increasing clinical evidence that HBO2 is an effective adjunct therapy for treatment of complications of irradiation in head and neck area.
Article – 3 - Delayed radiation injury to soft tissue and bone (radionecrosis)
Title: Hyperbaric oxygen therapy for radiation myelitis
Authors: Poulton, TJ; Witcofski, RL
Digital Object Identifier (or PMID etc): PMID: 4082347
Keywords: Animals, Female, Hyperbaric Oxygenation Myelitis/*therapy Radiation Injuries, Experimental/*therapy, Rats, Spinal Cord/*radiation effects
Abstract: Radiation therapy may damage healthy tissues adjacent to tumor. Hyperbaric oxygen therapy (HBO) is useful in treating soft tissue and osteoradionecrosis. In addition, HBO has been recommended to treat radiation-induced myelitis. We used radiation to induce a predictable myelitis in the spinal cords of rats who were randomized into treatment (HBO) and control groups 8 wk after irradiation. Serial neurologic examination showed no benefit or harm as a result of HBO.
Conclusion: This small pilot study did not demonstrate any clinically significant benefit of HBO for radiation myelitis in rats.
Article – 4 - Delayed radiation injury to soft tissue and bone (radionecrosis)
Title: Rate of delivery of hyperbaric oxygen treatments does not affect response in soft tissue radionecrosis.
Authors: Hampson, NB; Corman, JM
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: Soft tissue radiation necrosis (STRN) is effectively treated with hyperbaric oxygen (HBO,), believed to result from stimulation of angiogenesis in radiation-injured tissue. Thirty to forty HBO2 treatments are usually recommended for STRN. For various reasons, different hyperbaric facilities offer these treatments once or twice daily and from 5-7 days weekly. It is not known whether the clinical response differs as a result of the rate of administration of HBO2 treatments. Details of hyperbaric treatment courses of patients treated for radiation enteritis/proctitis (n = 65) and cystitis (n = 94) at a single institution were reviewed. Outcomes were compared with the total number of HBO2 treatments administered and also rate of treatment administration.
Results: Responses were similar for both forms of STRN whether the patient averaged fewer or greater than 5 treatments per week, or even < or = 3 versus > or = 7 treatments weekly. Outcome did differ, however, dependant on the total number of treatments administered. Response was better in patients receiving 30 or more total treatments, as compared with fewer.
Conclusion: Soft tissue radionecrosis of the gastrointestinal tract or bladder is (1) effectively treated with hyperbaric oxygen, (2) has a higher response rate if at least 30 treatments are administered, and (3) is equally responsive to rates of hyperbaric treatment ranging from 3 or fewer to 7 or more treatments per week.
Article – 5 - Delayed radiation injury to soft tissue and bone (radionecrosis)
Title: Hyperbaric oxygen therapy in hemorrhagic radiation cystitis: a report of 20 cases
Authors: Lee, HC; Liu, CS; Chiao, C; Lin, SN
Digital Object Identifier (or PMID etc): PMID: 7950806
Keywords: Nil
Abstract: Radiation cystitis with macroscopic hematuria has been a frustrating clinical problem for urologists. Since 1985 hyperbaric oxygen (HBO) has been used to treat this disease, showing favorable results. Between November 1989 and October 1992, 20 female patients with hemorrhagic radiation cystitis were treated with HBO at a pressure of 2.5 atm abs, breathing 100% O2 for 100 min in our multiplace hyperbaric chamber. After an average of 44 HBO sessions, macroscopic hematuria was completely halted in 16 patients (80%) and markedly decreased in 2 patients (10%). Comparison of the cystoscopic findings before and after HBO showed a significant decrease in hemorrhagic sites and telangiectasis of the bladder mucosa. One patient had urinary frequency and urgency without hematuria during her hospital stay. After 30 sessions of HBO therapy, her symptoms subsided, and the cystoscopic findings were much improved. Only one patient failed to respond to HBO and underwent ileal conduit diversion. The mean follow-up period was 14 mo. (5-41 mo.).
Conclusion: From our clinical results and cystoscopic findings, we suggest that HBO is an effective and safe treatment for hemorrhagic radiation cystitis.
Article – 6 - Delayed radiation injury to soft tissue and bone (radionecrosis)
Title: Chronic radiation proctitis treated with hyperbaric oxygen
Authors: Warren, DC; Feehan, P; Slade, JB; Cianci, PE
Digital Object Identifier (or PMID etc): PMID: 9308141
Keywords: Nil
Abstract: Chronic proctitis is a well-known complication of therapeutic irradiation. The results of hyperbaric oxygen therapy (HBO2) used in the treatment of chronic radiation proctitis are reported. From 1992 to 1995, 14 patients with chronic radiation-induced proctitis were treated with HBO2. Nine patients were treated in a monoplace chamber at 2.0 atm abs (203 kPa O2), and five patients were treated at 2.36 atm abs (239 kPa O2). Eight patients experienced complete resolution of symptoms and one patient had substantial improvement for a total response rate of 64%. Follow-up ranged from 5 to 35 mo. (mean 17 mo.). Five patients (36%) were classified as non-responders. Three experienced significant improvement during treatment but relapsed soon after therapy was discontinued, whereas two had no symptomatic improvement. Responders who had sigmoidoscopy after therapy showed documented improvement whereas no non-responders showed improvement.
Conclusion: The authors conclude that HBO2 therapy should be considered in patients with chronic radiation proctitis.
Article – 7 - Delayed radiation injury to soft tissue and bone (radionecrosis)
Title: Hyperbaric oxygen treatment for symptomatic breast edema after radiation therapy
Authors: Carl, UM; Hartmann, KA
Digital Object Identifier (or PMID etc): PMID: 9883492
Keywords: Nil
Abstract: A 54-yr-old woman with a pT2pN0 breast cancer developed a long-standing symptomatic breast edema after lumpectomy and radiation therapy. The breast edema did not respond to non-steroidal anti-inflammatory drugs (NSAIDs) and manual lymph drainage of her arm. Three years after completion of radiation therapy, hyperbaric oxygen (HBO2) treatment was initiated. Fifteen HBO2 sessions were performed at a pressure of 240 kPa over 90 min in a multiplace chamber. At the end of treatment, breast discomfort had subsided completely, and 5 mo. after completing HBO2 therapy the patient is still free of complaints.
Conclusion: We conclude from this observation that the value of HBO2 in the management of symptomatic radiation-induced breast edema should be investigated in a clinical study, because other effective treatment options are not available for this condition.
Article – 8 - Delayed radiation injury to soft tissue and bone (radionecrosis)
Title: Management of ischemic hemorrhagic cystitis with hyperbaric oxygen therapy
Authors: Lopez, AE; Rodriguez, S; Flores, I
Digital Object Identifier (or PMID etc): PMID: 11732883
Keywords: Nil
Abstract: We report a case of a T8 paraplegic woman who experienced necrosis of the bladder due to inadvertent chronic over distention. After bladder repair, the patient suffered from severe ischemic hemorrhagic cystitis. Despite many attempts to control the bleeding with standard treatments, the hematuria continued. Although hyperbaric oxygen (HBO2) therapy has not been proven to be helpful in patients with hemorrhagic cystitis not related to radiation or chemotherapy, the physiopathologic mechanisms of the cysttis, involving ischemia, led us to believe that outpatient would benefit from HBO2 therapy in analogy to the approved use of HBO2 therapy in radiation cystitis. Since the use of HBO2 therapy has not been previously reported in this situation, we met with some hesitation from the HBO2 therapy department.
Conclusion: After reviewing the literature and discussing the case, a medical panel reached a consensus to allow us to commence the treatment. The patient had a remarkable response, and remains without hematuria 6 mo. after treatment.
Article – 9 - Delayed radiation injury to soft tissue and bone (radionecrosis)
Title: Hyperbaric oxygen as prophylaxis or treatment for radiation myelitis
Authors: Feldmeier, JJ; Lange, JD; Cox, SD; Chou, LJ; Ciaravino, V
Digital Object Identifier (or PMID etc): PMID: 8401154
Keywords: Nil
Abstract: This animal study was designed to investigate HBO as a treatment or prophylaxis for radiation myelitis. All animals received identical spinal cord radiation doses of 69 Gy in 10 daily fractions. Group I received no HBO; group II began HBO at the onset of signs of myelitis; group III received HBO with prophylactic intent beginning 6 wk after irradiation; and group IV received both modalities on the same day, but radiation always preceded HBO by at least 4 h. HBO consisted of 90 min oxygen at 2.4 atm abs for 20 daily treatments. Animals were objectively assessed for the loss of certain neurologic reflexes indicative of four levels of myelitis. Although all animals progressed to severe myelitis, group III animals had group-averaged levels of myelitis consistently less than control. The differences were statistically significant for several weeks. Group IV animals progressed to severe myelitis much more rapidly than any other group.
Conclusion: Additional study is justified by this trial. Key questions to be answered include the optimal timing of HBO to produce a beneficial rather than detrimental effect.
Article – 10 - Delayed radiation injury to soft tissue and bone (radionecrosis)
Title: Hyperbaric oxygen in the treatment of delayed radiation injuries of the extremities
Authors: Feldmeier, JJ; Heimbach, RD; Davolt, DA; McDonough, MJ; Stegmann, BJ; Sheffield, PJ
Digital Object Identifier (or PMID etc): PMID: 10813435
Keywords: Nil
Abstract: Hyperbaric oxygen (HBO2) is used as an adjunct in the treatment of radiation injury at many sites, including the mandible, larynx, chest wall, bladder, and rectum. In these disorders, HBO2 is effective in stimulating neovascularization and reducing fibrosis. No previous publications report the application of HBO2 to radiation injuries of the extremities. From 1979 until 1997, 17 patients were treated at the Southwest Texas Methodist and Nix Hospitals for nonhealing necrotic wounds of the extremities within previously irradiated fields. All but one wound involved a lower extremity. Most of the patients had been irradiated for soft tissue sarcomas or skin cancers. The rest were irradiated for a variety of malignancies. HBO2 was delivered in a multiplace chamber at 2.4 atm abs daily for 90 min of 100% oxygen at pressure. This report is a retrospective, uncontrolled review of these patients. Eleven patients (65%) healed completely whereas five (29%) failed to heal and one (6%) was lost to follow-up. Three (60%) of those who failed were found to have local or distant recurrence of their tumor early in their course of hyperbaric treatment and were discontinued from therapy at that time. When last seen in the clinic, the wound of the patient who was lost to follow-up was improved but not completely healed. Four of those who failed (including the two with local tumor recurrence) required amputation. If we exclude those with active cancer and the patient lost to follow-up, the success rate was 11 of 13 or 85%. HBO2 was applied successfully with complete wound healing and the avoidance of amputation in a majority of these patients. The consequences of failure in patients suffering from radiation necrosis of the extremities (some complicated by the presence of tumor) are significant, with 80% of the five failures requiring amputation.
Conclusion: In radiation injuries of the extremities as in delayed radiation injury at other sites, HBO2 is a useful adjunct and should be part of the overall management.