Double-blind randomized phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy

Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema after radiotherapy for cancer

“…This randomised trial failed to confirm earlier reports of benefit of HBO in women with chronic arm lymphoedema following adjuvant radiotherapy to the lymphatic pathways [23,24]. One possible explanation is that patients in our previous studies became better at managing their lymphoedema through contact with other patients and health professionals during the course of the research.…”

“…In a previous study testing HBO in patients with radiation-induced brachial plexopathy, we detected no evidence of effect [23]. However, 2/6 cases with co-existing chronic arm lymphoedema reported major and persistent improvements in arm volume for at least 12 months after treatment with HBO.…”

“…In most patients, the supraclavicular field includes the level III nodes, and standard tangential fields to the breast or chest wall include the lower axilla (corresponding to level I). Perhaps the long average interval (almost 12 years) between radiotherapy and HBO was just too long to enable remodelling of mature fibrotic tissue, although one of the most dramatic complete responses in our first study was seen in a woman with gross lymphoedema of 20 years duration [23]. The long average interval in the present trial reflected the scarcity of patients currently treated in the UK with axillary radiotherapy, a practice that may now be returning in the context of positive axillary sentinel node biopsy [33].…”

Hyperbaric Oxygen and Radiotherapy

“…Late radiation sequelae to the breast [8,19,23,33,64,69]. Table 6 shows five papers dealing with late sequelae of breast cancer radiotherapy encompassing late effects like breast and arm lymphedema, brachial plexopathy as well as soft-tissue and bone necrosis of the chest wall.…”

Radiation induced brachial plexopathies

“…There is no reliable evidence to support the hypothesis that hyperbaric oxygen (HBO2) therapy slows or reverses radiation induced plexopathies in a substantial proportion of affected individuals, although improvements in sensory threshold offer some suggestion of therapeutic effect [35]. Pain relief might be achieved with neurolysis but no recovery of either the sensory or the motor function impairment has been shown.…”