Hyperbaric oxygen for late radiation tissue toxicity – pro
Radiation therapy can have proximal as well as delayed(late) radiation tissue injury(LRTI). LRTI affecting the head, neck and lower end of the bowel can be improved with HBOT. There is little evidence for or against benefit in other tissues affected by LRTI and this conclusion is based on eight randomised trials with a limited number of patients. Cochrane guideline recommends more study. There is an ongoing trial: Study to Determine if Hyperbaric Oxygen Therapy is Helpful for Treating Radiation Tissue Injuries, NCT00134628.
The Canadian Agency for Drugs and Technologies in Health’s review on the use of HBOT for difficult wound (Boudreau et al, 2010) identified 7 health technology assessments, 5 systematic reviews, and 1 RCT. Overall, the authors of the identified studies found that HBOT was clinically effective as well as cost-effective when it was used to treat patients with diabetes who have lower extremity chronic ulcers. There was some positive evidence to suggest that HBOT was clinically effective when it was used to treat radiation proctitis. The evidence base was considered insufficient to promote the routine use of HBOT for non-diabetic pressure ulcers, delayed radiation-induced injury, thermal burns, as well as skin grafts and flaps. No evidence was identified on the use of HBOT in post-organ transplantation re-vascularization. The authors concludd that overall, the best evidence on the use of adjunctive HBOT was associated with the treatment of chronic diabetic wounds. The evidence that supported its use, however, was not reliable. Although there were many recommendations on the use of HBOTas adjunctive treatment for specific indications, there is little evidence on its clinical and economic benefits.
According to the Department of Health and Human Services OFFICE OF INSPECTOR GENERAL (http://oig.hhs.gov/oei/reports/oei-06-99-00090.pdf), depending on the response of the individual patient and the severity of the original problem, treatment may range from less than 1 week to several months duration, the average being 2 to 4 weeks.
Another interesting application is for treatment of autism but thus far the evidence for its efficacy is not compelling.
Bennett MH, Feldmeier J, Hampson N, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD005005
Gesell, Laurie B. (Chair and editor) (2008). Hyperbaric Oxygen Therapy Indications. The Hyperbaric Oxygen Therapy Committee Report (12 ed.). Durham, NC: Undersea and Hyperbaric Medical Society. ISBN 0930406230.
Boudreau R, Moulton K, McGill S. Hyperbaric oxygen therapy for difficult wound healing: Systematic review of clinical effectiveness and cost-effectiveness. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2010. available at: http://64.26.163.205/media/pdf/M0016_HBOT_L3_e.pdf.