Hyperbaric oxygen therapy and delayed radiation injuries (soft tissue and bony necrosis): 2012 update.
Informal surveys at CME meetings have shown that approximately one-third of patients in the United States receive hyperbaric oxygen (HBO2) for delayed radiation injury. More than 600,000 patients receive radiation for malignancy in our country annually, and about one-half will be long-term survivors. Serious radiation complications occur in 5-10% of survivors. A large population of patients is therefore at risk for radiation injury. HBO2 has been applied to treat patients with radiation injury since the mid-1970s. Published results are consistently positive, but the level of evidence for individual publications is usually not high level, consisting mostly of case series and case reports. Only a rare randomized controlled trial has been accomplished. Radiation injury is one of the UHMS "approved" indications, and third-party payors will usually reimburse for this application. This updated review summarizes the publications available reporting results in treating radiation-injured patients. Mechanisms of HBO2 in radiation injury are discussed briefly. Outcome is reported on a mostly anatomic basis though due to the nature of the injury a positive outcome at one anatomic site is supportive of HBO2 at other sites. The potential benefit of prophylactic HBO2 before frank damage is also discussed in high-risk patients. The concerns of HBO2 enhancing growth of or precipitating recurrence of malignancy is discussed and largely refuted.
Radiation Oncology, University of Toledo Medical Center, Toledo, Ohio, USA. jfeldmeier@aol.com
John J
JJ
Feldmeier
D000005:Abdomen / Q000473:pathology / Q000528:radiation effects; D003238:Connective Tissue / Q000473:pathology / Q000528:radiation effects*; D003556:Cystitis / Q000209:etiology / Q000628:therapy; D004751:Enteritis / Q000209:etiology / Q000628:therapy; D005121:Extremities / Q000473:pathology / Q000528:radiation effects; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects / Q000379:methods*; D007830:Larynx / Q000473:pathology / Q000528:radiation effects; D008334:Mandible / Q000473:pathology / Q000528:radiation effects; D009336:Necrosis / Q000473:pathology / Q000628:therapy; D009420:Nervous System / Q000473:pathology / Q000528:radiation effects; D010025:Osteoradionecrosis / Q000473:pathology / Q000628:therapy*; D010388:Pelvis / Q000473:pathology / Q000528:radiation effects; D011349:Proctitis / Q000209:etiology / Q000628:therapy; D011832:Radiation Injuries / Q000473:pathology / Q000517:prevention & control / Q000628:therapy*; D035441:Thoracic Wall / Q000473:pathology / Q000528:radiation effects