Hyperbaric Oxygen Therapy for Late Radiation Tissue Injury in Gynecologic Malignancies

Abstract

Background: Late radiation tissue injury is a serious complication of radiotherapy for patients with gynecologic malignancies. Strategies for managing pain and other clinical features have limited efficacy; however, hyperbaric oxygen therapy (HBO2) may be an effective option for some patients. Methods: In a systematic review of the literature, the Ovid medline, embase, Cochrane Library, National Guidelines Clearinghouse, and Canadian Medical Association Infobase databases were searched to June 2009 for clinical practice guidelines, systematic reviews, randomized controlled trials, or other relevant evidence. Studies that did not evaluate soft tissue necrosis, cystitis, proctitis, bone necrosis, and other complications were excluded. Results: Two randomized trials, eleven nonrandomized studies, and five supporting documents comprise the evidence base. In addition, information on the harms and safety of treatment with HBO2 were reported in three additional sources. There is modest direct evidence and emerging indirect evidence that the use of HBO2 is broadly effective for late radiation tissue injury of the pelvis in women treated for gynecologic malignancies. Conclusions: Based on the evidence and expert consensus opinion, (1) HBO2 is likely effective for late radiation tissue injury of the pelvis, with demonstrated efficacy specifically for radiation damage to the anus and rectum; (2) the main indication for HBO2 therapy in gynecologic oncology is in the management of otherwise refractory chronic radiation injury; (3) HBO2 may provide symptomatic benefit in certain clinical settings (for example, cystitis, soft-tissue necrosis, and osteonecrosis); (4) and HBO2 may reduce the complications of gynecologic surgery in patients undergoing surgical removal of necrosis.

Management of toxicities following pelvic irradiation for gynaecological cancers

“…This inhibits the ability of the tissue to repair itself causing nonhealing ulcers [18]. Hyperbaric oxygen (HBO) promotes repair of radiation-induced vascular changes by inducing neovascularization that reverses tissue hypoxia and stimulates collagen deposition and fibroblast proliferation at wound edges.…”

Radiofrequency ablation for the treatment of radiation proctitis: a case report and review of literature

“…A randomized trial on 120 patients with CRP showed a significant clinical improvement with hyperbaric oxygen compared with a sham procedure [Clarke et al 2008]. It has been proposed that hyperbaric oxygen may inhibit bacterial growth [Hill and Osterhout, 1972], promote angiogenesis, and inhibit toxin production [Craighead et al 2011]. This method is not widely used due to its cost and limited availability.…”

Hyperbaric Oxygen as and Adjust to Management of Periocular Necrotizing Fasciitis: A Report of 2 Cases

“…HBO has been approved for use as an adjunct in managing 15 different conditions, including decompression sickness, arteriolar gas embolus, non-healing diabetic foot ulcers [5], psoriasis [6], late radiation tissue injury in gynecologic malignancies [7], and autism [8], as well as progressive, necrotizing soft tissue infections. It has been used "off-label" uses include cerebral palsy, established strokes, autism, multiple sclerosis, injury.…”