title: The efficacy of hyperbaric oxygen therapy in the treatment of medically refractory soft tissue necrosis after penile brachytherapy.
abstract: OBJECTIVE
  Soft tissue necrosis is reported in up to 26% of patients undergoing radiotherapy for penile cancer. Management options include local irrigation, wound debridement, antibiotics, anti-inflammatory medication, and analgesics. Refractory lesions may be treated with partial penectomy. Hyperbaric oxygen therapy (HBO) has a well-defined role in the treatment of late radiation toxicities. We present experience with HBO for medically refractory soft tissue necrosis after penile brachytherapy.
  
  
  METHODS
  From November 2001 to January 2009, 7 men of 43 treated with penile brachytherapy for squamous carcinoma developed refractory soft tissue necrosis and were treated with HBO. All had received a prescribed dose of 60 Gy through interstitial brachytherapy using Paris system guidelines. All had failed conservative medical therapies for soft tissue necrosis.
  
  
  RESULTS
  Median age was 55 years (range, 35-72 years). Comorbidities potentially effecting wound healing included hypertension (2), current smokers (5), former smoker (1) but no diabetes mellitus, or peripheral vascular disease. Median time between completion of brachytherapy and appearance of soft tissue necrosis was 13 months (range, 9-24 months) and the median interval before starting HBO was 7.5 months (range, 3-13 months). The median number of "dives" per HBO course was 40 (30-53). All 7 experienced an excellent response with healing of the necrosis and resolution of symptoms, although 3 required an additional course, 2 for consolidation of healing, and 1 for a relapse 4 months later. No patient was submitted to penectomy.
  
  
  CONCLUSIONS
  HBO should be considered as a treatment option in patients with refractory soft tissue necrosis of the penis after brachytherapy.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Gomez-Iturriaga
authors.forename: Juanita
authors.initials: J
authors.lastname: Crook
authors.forename: Wayne
authors.initials: W
authors.lastname: Evans
authors.forename: Elantholi P
authors.initials: EP
authors.lastname: Saibishkumar
authors.forename: John
authors.initials: J
authors.lastname: Jezioranski
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010412:Penile Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000628:therapy*; D011879:Radiotherapy Dosage; D012867:Skin / Q000473:pathology*