Bennett MH, Feldmeier J, Hampson NB, Smee R, Milross C, et al.
The Cochrane database of systematic reviews. Date of publication 2016 Apr 28;volume 4():CD005005.
1. Cochrane Database Syst Rev. 2016 Apr 28;4:CD005005. doi:
10.1002/14651858.CD005005.pub4.
Hyperbaric oxygen therapy for late radiation tissue injury.
Bennett MH(1), Feldmeier J, Hampson NB, Smee R, Milross C.
Author information:
(1)Department of Anaesthesia, Prince of Wales Clinical School, University of NSW,
Sydney, NSW, Australia.
Update of
Cochrane Database Syst Rev. 2012;(5):CD005005.
BACKGROUND: Cancer is a significant global health problem. Radiotherapy is a
treatment for many cancers and about 50% of people having radiotherapy will be
long-term survivors. Some will experience late radiation tissue injury (LRTI)
developing months or years later. Hyperbaric oxygen therapy (HBOT) has been
suggested as a treatment for LRTI based upon the ability to improve the blood
supply to these tissues. It is postulated that HBOT may result in both healing of
tissues and the prevention of problems following surgery.
OBJECTIVES: To assess the benefits and harms of HBOT for treating or preventing
LRTI.
SEARCH METHODS: We updated the searches of the Cochrane Central Register of
Controlled Trials (CENTRAL; 2015, Issue 11), MEDLINE, EMBASE, DORCTIHM and
reference lists of articles in December 2015. We also searched for ongoing trials
at clinicaltrials.gov.
SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the effect of
HBOT versus no HBOT on LRTI prevention or healing.
DATA COLLECTION AND ANALYSIS: Three review authors independently evaluated the
quality of the relevant trials using the guidelines of the Cochrane Handbook for
Systematic Reviews of Interventions and extracted the data from the included
trials.
MAIN RESULTS: Fourteen trials contributed to this review (753 participants).
There was some moderate quality evidence that HBOT was more likely to achieve
mucosal coverage with osteoradionecrosis (ORN) (risk ratio (RR) 1.3; 95%
confidence interval (CI) 1.1 to 1.6, P value = 0.003, number needed to treat for
an additional beneficial outcome (NNTB) 5; 246 participants, 3 studies). There
was also moderate quality evidence of a significantly improved chance of wound
breakdown without HBOT following operative treatment for ORN (RR 4.2; 95% CI 1.1
to 16.8, P value = 0.04, NNTB 4; 264 participants, 2 studies). From single
studies there was a significantly increased chance of improvement or cure
following HBOT for radiation proctitis (RR 1.72; 95% CI 1.0 to 2.9, P value =
0.04, NNTB 5), and following both surgical flaps (RR 8.7; 95% CI 2.7 to 27.5, P
value = 0.0002, NNTB 4) and hemimandibulectomy (RR 1.4; 95% CI 1.1 to 1.8, P
value = 0.001, NNTB 5). There was also a significantly improved probability of
healing irradiated tooth sockets following dental extraction (RR 1.4; 95% CI 1.1
to 1.7, P value = 0.009, NNTB 4).There was no evidence of benefit in clinical
outcomes with established radiation injury to neural tissue, and no randomised
data reported on the use of HBOT to treat other manifestations of LRTI. These
trials did not report adverse events.
AUTHORS' CONCLUSIONS: These small trials suggest that for people with LRTI
affecting tissues of the head, neck, anus and rectum, HBOT is associated with
improved outcome. HBOT also appears to reduce the chance of ORN following tooth
extraction in an irradiated field. There was no such evidence of any important
clinical effect on neurological tissues. The application of HBOT to selected
participants and tissues may be justified. Further research is required to
establish the optimum participant selection and timing of any therapy. An
economic evaluation should be undertaken.
DOI: 10.1002/14651858.CD005005.pub4
PMID: 27123955 [Indexed for MEDLINE]
