Lin ZC, Bennett MH, Hawkins GC, Azzopardi CP, Feldmeier J, Smee R, Milross C, et al.
The Cochrane database of systematic reviews. Date of publication 2023 Aug 15;volume 8(8):CD005005.
1. Cochrane Database Syst Rev. 2023 Aug 15;8(8):CD005005. doi:
10.1002/14651858.CD005005.pub5.
Hyperbaric oxygen therapy for late radiation tissue injury.
Lin ZC(1), Bennett MH(2)(3), Hawkins GC(4), Azzopardi CP(5), Feldmeier J(6),
Smee R(7), Milross C(8).
Author information:
(1)Hyperbaric Service, Department of Intensive Care and Hyperbaric Medicine, The
Alfred Hospital, Melbourne, Australia.
(2)Department of Anaesthesia, Prince of Wales Clinical School, University of
NSW, Sydney, Australia.
(3)Academic Head, Wales Anaesthesia and Department of Diving and Hyperbaric
Medicine, Prince of Wales Clinical School, Sydney, Australia.
(4)UNSW Medicine, Prince of Wales Clinical School, Sydney, Australia.
(5)Hyperbaric Unit, Mater Dei Hospital, Msida, Malta.
(6)Department of Radiation Oncology, Medical College of Ohio, Toledo, Ohio, USA.
(7)Department of Radiation Oncology, Prince of Wales Hospital, Randwick,
Australia.
(8)Radiation Oncology and Medical Services, Chris O'Brien Lifehouse, Camperdown,
Australia.
Update of
Cochrane Database Syst Rev. 2016 Apr 28;4:CD005005.
BACKGROUND: This is the third update of the original Cochrane Review published
in July 2005 and updated previously in 2012 and 2016. Cancer is a significant
global health issue. Radiotherapy is a treatment modality for many malignancies,
and about 50% of people having radiotherapy will be long-term survivors. Some
will experience late radiation tissue injury (LRTI), developing months or years
following radiotherapy. Hyperbaric oxygen therapy (HBOT) has been suggested as a
treatment for LRTI based on 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 complications following surgery and radiotherapy.
OBJECTIVES: To evaluate the benefits and harms of hyperbaric oxygen therapy
(HBOT) for treating or preventing late radiation tissue injury (LRTI) compared
to regimens that excluded HBOT.
SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest
search date was 24 January 2022.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing
the effect of HBOT versus no HBOT on LRTI prevention or healing.
DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary
outcomes were 1. survival from time of randomisation to death from any cause; 2.
complete or substantial resolution of clinical problem; 3. site-specific
outcomes; and 4.
ADVERSE EVENTS: Our secondary outcomes were 5. resolution of pain; 6.
improvement in quality of life, function, or both; and 7. site-specific
outcomes. We used GRADE to assess certainty of evidence.
MAIN RESULTS: Eighteen studies contributed to this review (1071 participants)
with publications ranging from 1985 to 2022. We added four new studies to this
updated review and evidence for the treatment of radiation proctitis, radiation
cystitis, and the prevention and treatment of osteoradionecrosis (ORN). HBOT may
not prevent death at one year (risk ratio (RR) 0.93, 95% confidence interval
(CI) 0.47 to 1.83; I2 = 0%; 3 RCTs, 166 participants; low-certainty evidence).
There is some evidence that HBOT may result in complete resolution or provide
significant improvement of LRTI (RR 1.39, 95% CI 1.02 to 1.89; I2 = 64%; 5 RCTs,
468 participants; low-certainty evidence) and HBOT may result in a large
reduction in wound dehiscence following head and neck soft tissue surgery (RR
0.24, 95% CI 0.06 to 0.94; I2 = 70%; 2 RCTs, 264 participants; low-certainty
evidence). In addition, pain scores in ORN improve slightly after HBOT at 12
months (mean difference (MD) -10.72, 95% CI -18.97 to -2.47; I2 = 40%; 2 RCTs,
157 participants; moderate-certainty evidence). Regarding adverse events, HBOT
results in a higher risk of a reduction in visual acuity (RR 4.03, 95% CI 1.65
to 9.84; 5 RCTs, 438 participants; high-certainty evidence). There was a risk of
ear barotrauma in people receiving HBOT when no sham pressurisation was used for
the control group (RR 9.08, 95% CI 2.21 to 37.26; I2 = 0%; 4 RCTs, 357
participants; high-certainty evidence), but no such increase when a sham
pressurisation was employed (RR 1.07, 95% CI 0.52 to 2.21; I2 = 74%; 2 RCTs, 158
participants; high-certainty evidence).
AUTHORS' CONCLUSIONS: These small studies suggest that for people with LRTI
affecting tissues of the head, neck, bladder and rectum, HBOT may be associated
with improved outcomes (low- to moderate-certainty evidence). HBOT may also
result in a reduced risk of wound dehiscence and a modest reduction in pain
following head and neck irradiation. However, HBOT is unlikely to influence the
risk of death in the short term. HBOT also carries a risk of adverse events,
including an increased risk of a reduction in visual acuity (usually temporary)
and of ear barotrauma on compression. Hence, the application of HBOT to selected
participants may be justified. The small number of studies and participants, and
the methodological and reporting inadequacies of some of the primary studies
included in this review demand a cautious interpretation. More information is
required on the subset of disease severity and tissue type affected that is most
likely to benefit from this therapy, the time for which we can expect any
benefits to persist and the most appropriate oxygen dose. Further research is
required to establish the optimum participant selection and timing of any
therapy. An economic evaluation should also be undertaken.
Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.
DOI: 10.1002/14651858.CD005005.pub5
PMCID: PMC10426260
PMID: 37585677 [Indexed for MEDLINE]
Conflict of interest statement: ZCL: none. ZCL is a trainee in diving,
hyperbaric and emergency medicine. MB: none. MB is a hyperbaric physician who
regularly treats people with LRTI. GCH: none. GCH is a hyperbaric physician who
regularly treats people with LRTI. CPA: none. CPA is a hyperbaric physician who
regularly treats people with LRTI. JF: none. JF has previous hyperbaric
experience and is a radiation oncologist who refers people with LRTI for HBOT.
RS: none. RS is a radiation oncologist who refers people with LRTI for HBOT. CM:
none. CM is a radiation oncologist who refers people with LRTI for HBOT.
