Hyperbaric oxygen therapy for late radiation tissue injury

Area of Science:

• Oncology and Radiation Medicine
• Hyperbaric Medicine
• Tissue Repair and Regeneration

Background:

• Radiotherapy is a common cancer treatment, with survivors often experiencing late radiation tissue injury (LRTI) months or years post-treatment.
• Hyperbaric oxygen therapy (HBOT) is proposed to treat LRTI by enhancing blood supply to damaged tissues.
• This review evaluates HBOT's efficacy and safety in managing or preventing LRTI.

Approach:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing HBOT with non-HBOT regimens for LRTI.
• Searched extensively using Cochrane methods, with the latest search on January 24, 2022.
• Analyzed primary outcomes including survival, clinical problem resolution, and site-specific outcomes, alongside secondary outcomes like pain and quality of life.

Key Points:

• HBOT may lead to complete resolution or significant improvement of LRTI (low-certainty evidence).
• HBOT demonstrated a reduction in wound dehiscence after head and neck surgery (low-certainty evidence).
• Pain scores in osteoradionecrosis (ORN) showed slight improvement with HBOT at 12 months (moderate-certainty evidence).
• HBOT is associated with an increased risk of reduced visual acuity and ear barotrauma (high-certainty evidence).

Conclusions:

• HBOT may offer benefits for LRTI in head, neck, bladder, and rectal tissues, alongside reduced wound dehiscence and pain.
• The therapy carries risks, including visual acuity reduction and ear barotrauma, necessitating careful patient selection.
• Further research is needed to optimize HBOT protocols, identify ideal patient subsets, and assess long-term efficacy and cost-effectiveness.