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Outcomes of Radiation Injuries Using Hyperbaric Oxygen Therapy: An Observational Cohort Study
Jeffrey A Niezgoda1, Thomas E Serena, Marissa J Carter
1Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS, is President, American College of Hyperbaric Medicine; President/Chief Medical Officer, WebCME; President/Chief Medical Officer, AZH; and Industry Consultant for Hyperbaric and Wound Care, Milwaukee, Wisconsin. Thomas E. Serena, MD, FACS, FACHM, MAPWCA, is Founder/Chief Executive Officer/Medical Director, SerenaGroup, Cambridge, Massachusetts; President, American Professional Wound Care Association; and Vice President, American College of Hyperbaric Medicine. Marissa J. Carter, PhD, MAPWCA, is President, Strategic Solutions, Inc, Cody, Wyoming. Drs Niezgoda and Serena have disclosed that the American College of Hyperbaric Medicine has received funding from the Eric P. Kindwall, MD, Foundation. Dr Carter has disclosed that her company is remunerated for participation in review activities such as data monitoring boards, statistical analysis, and end point committees, and received payment for writing or reviewing the manuscript; and she is a consultant to the SerenaGroup.
Background:
The late effects of radiation therapy following the treatment of cancer are a well-known consequence. Evidence increasingly supports the use of hyperbaric oxygen (HBO) as an adjunctive treatment in a variety of radiation injuries.
Objective:
To present the findings of a new registry of radiation injuries that was developed to evaluate the outcomes and treatment parameters of HBO treatment (HBOT) when applied to patients experiencing the late effects of radiation therapy.
Design:
Observational cohort.
Setting:
Hyperbaric oxygen clinical treatment facilities in the United States.
Patients:
A total of 2538 patients with radiation-induced injuries.
Measurements:
Injury type, patient age, gender, diabetes, end-stage renal disease, collagen vascular disease, coronary artery disease/peripheral vascular disease, on anticoagulant medication, on systemic steroid medication, patient is current smoker, patient abuses alcohol, symptoms reported, duration of symptoms, symptom progression prior to HBOT, transfusion units, HBOT time, HBOT count, HBO chamber pressure, HBO time in chamber, and patient outcomes.
Results:
A total of 2538 patient entries with 10 types of radiation injuries were analyzed. The 5 most common injuries were osteoradionecrosis (33.4%), dermal soft tissue radionecrosis (27.5%), radiation cystitis (18.6%), radiation proctitis (9.2%), and laryngeal radionecrosis (4.8%). Clinical outcomes following HBOT were positive with symptoms that improved or resolved varying from 76.7% to 92.6%, depending on injury type. Overall, although the mean symptom improvement score between some groups is statistically significant, the differences are probably not clinically meaningful. Patients with osteoradionecrosis had the highest mean symptom improvement score (3.24) compared with a mean of 3.04 for laryngeal radionecrosis.
Limitations:
Limited data were available on patient comorbidities and symptom severity.
Conclusions:
Outcomes from a large patient registry of radiation-induced injuries support the continued therapeutic use of HBOT for radiation injuries.
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