Treatment of Cerebral Radionecrosis by Hyperbaric Oxygen Therapy

Abstract

Clinically observed adverse radiation effects (ARE) are rather uncommon, but modern imaging reveals that they are more common after radiosurgery than previously believed. Little is known about the pathogenesis, and current treatment is mostly empirical. The benefit of hyperbaric oxygen therapy (HBO) on radiation-induced bone and soft tissue necrosis is known in lesions in the maxillofacial area, the mouth and in the head and neck. HBO raises the tissue pO₂ and initiates a cellular and vascular repair mechanism. This forms the basis for the hypothesis that it might also help alleviate the results of cerebral radionecrosis. This study is a preliminary attempt to test this hypothesis. Two patients with arteriovenous malformations (AVMs) were chosen for the study. They had been treated with Gamma Knife radiosurgery (GKRS) and had developed imaging signs consistent with ARE. They were treated by breathing 100% oxygen at 2.5 atmospheres absolute (250 kPa) in sessions of 60 minutes per day. This treatment was repeated 40 times in cycles of ten sessions. Both responded well to HBO, one lesion disappeared and the other was reduced significantly in size. No adjuvant steroids were given. These results give evidence that HBO has a potential value in treating ARE but further experience will be needed to confirm its definite benefit.

Laser Interstitial Thermal Therapy for Focal Cerebral Radiation Necrosis: A Case Report and Literature Review

“…Clinically, Hart and Mainous [45] first used HBO more than 30 years ago to treat 69 patients with various forms of radiation-induced injury. Various others have since reported their experience with the use of HBO in RN [5,46,47,48]. Because of the retrospective nature of data collection, and a majority of patients having received varying doses of concurrent steroids, evidence to support the use of HBO in radionecrosis remains weak [44].…”

Disease progression or pseudoprogression after concomitant radiochemotherapy treatment: Pitfalls in neurooncology

“…Some authors advocate the use of hyperbaric oxygen, the rationale for its use hinging on the fact that hyperbaric oxygen increases the tissue pO 2 and enhances angiogenesis; results following this approach have been promising. 40,41 More recently, in a series of eight patients, bevacizumab, a humanized murine monoclonal antibody against vascular endothelial growth factor, alone and in combination with other agents, was found to be effective against radionecrosis, the mechanism underlying its efficacy probably being an ability to decrease capillary leakage, thus minimizing any associated brain edema. 42 MRS may be a useful tool for tracing a flow chart for the treatment of early progressive/pseudoprogressive lesions, and adjuvant chemotherapy should be stopped …”

Delayed Radiation Necrosis With Extensive Brain Edema After Gamma Knife Radiosurgery for Multiple Cerebral Cavernous Malformations-Case Report-

“…Reactive astrocytes were recognized in the ring-enhanced lesion, so destruction of the blood-brain barrier may have been involved in the present case. 21) HBO therapy is a useful treatment for radiation necrosis, 14) and, in the present case, was effective in improving the MR imaging findings of radiation necrosis, i.e., the abnormal ring enhancement after gadolinium administration associated with extensive brain edema. 1) HBO therapy increases the tissue PO 2 , which may facilitate cellular and vascular repair.…”