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Entre la esperanza y la incertidumbre: la esquiva evidencia sobre la oxigenoterapia hiperbárica y la radioterapia
Francesco Cuccia1, Andrea Neville Cracchiolo2, Antonio Piras3
1Radiation Oncology, ARNAS Civico Hospital - Palermo, Palermo, Italy. francesco.cuccia@arnascivico.it.
Resumen
La oxigenoterapia hiperbárica (OTH) muestra resultados prometedores para el manejo de la lesión tisular tardía por radiación, especialmente las toxicidades pélvicas. Sin embargo, su eficacia varía según el sitio del cáncer y se necesita más investigación para confirmar sus beneficios y su uso óptimo.
Área de la Ciencia:
- Oncología; Radioterapia; Medicina Hiperbárica
Sus antecedentes:
- La lesión tisular tardía por radiación (LTTR) afecta a ~5% de los pacientes con cáncer después de la radioterapia (RT), impactando la calidad de vida.; La oxigenoterapia hiperbárica (OTH) se explora para toxicidades inducidas por RT y como radiosensibilizador, pero la evidencia es limitada.
Objetivo del estudio:
- Revisar sistemáticamente la eficacia y seguridad de la oxigenoterapia hiperbárica (OTH) en pacientes en tratamiento de radioterapia (RT).; Evaluar el papel de la OTH en el manejo de la lesión tisular tardía por radiación (LTTR) y sus posibles efectos radiosensibilizadores.
Principales métodos:
- Revisión sistemática de las bases de datos PubMed, Embase y Cochrane (2000-2025).; Se incluyeron estudios que evaluaron la OTH en pacientes con RT; se excluyeron revisiones y pequeños informes de casos.; Los datos extraídos incluyeron diseño del estudio, detalles del paciente/tratamiento, parámetros de OTH, resultados y toxicidad.
Principales resultados:
- 42 estudios (2785 pacientes) analizados; 28 retrospectivos, 5 ECAs.; La OTH mostró altas tasas de respuesta (67-100%) para toxicidades pélvicas como la cistitis hemorrágica.; Los beneficios en cánceres de mama/cabeza y cuello fueron inconsistentes entre los tipos de estudio; el perfil de seguridad fue generalmente bueno.
Conclusiones:
- La OTH es prometedora para mitigar las toxicidades tardías de la RT, particularmente las pélvicas.; La evidencia para otros sitios es contradictoria y su papel radiosensibilizador es especulativo.; Son esenciales ensayos prospectivos bien diseñados para definir el uso óptimo de la OTH en pacientes con RT.
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