Successful treatment of radiation induced breast ulcer with hyperbaric oxygen

The purpose of this report was to investigate the efficacy of hyperbaric oxygen treatment in the management of a persisting radiation induced ulcer following standard breast irradiation. A 57-year-old Caucasian patient was referred following partial mastectomy and axillary node clearance for a T2N0 grade 3 infiltrating ductal carcinoma of the left breast. She received 45 Gy in 25 fractions at 1.8 Gy per fraction to the isocentre to the whole breast using tangential fields and 4 MV photons, in conjunction with intravenous chemotherapy (cyclophosphamide, methotrexate and 5 fluorouracil). Treatment was interrupted for 3.5 weeks because of a grade 4 skin and subcutaneous reaction. Treatment resumed to the tumour bed alone. Chemotherapy was abandoned. The tumour bed received 14 Gy in 7 fractions at 2 Gy per fraction prescribed to the 100% using 10 MeV electrons and a direct field, completing treatment on 7 July 1998. The radiation induced a painful 8x4 cm ulcer which persisted in spite of rigorous treatment including Gentian Violet, Silvazine Cream, Duoderm and antibiotics. The patient received 30 hyperbaric treatments, six times a week, completing treatment on 15 December 1998. The patient required insertion of bilateral ear grommets under local anaesthetic. The breast ulcer showed a response to treatment with early healing after 7-8 days and clinical evidence of re-epithelization. At completion of 30 treatments the patient was left with a small shallow faintly discharging multilocular 3-4 cm ulcer. The ulcer had completely healed by 14 January 1999. The patient has been symptom free since completion of treatment. This report highlights the efficacy of hyperbaric oxygen therapy in the management of persisting radiation-induced ulcers.