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Intervention Review

Hyperbaric oxygen therapy for late radiation tissue injury

  1. Michael H Bennett1,*,
  2. John Feldmeier2,
  3. Neil Hampson3,
  4. Robert Smee4,
  5. Christopher Milross5

Editorial Group: Cochrane Gynaecological Cancer Group

Published Online: 15 APR 2009

Assessed as up-to-date: 22 AUG 2008

DOI: 10.1002/14651858.CD005005.pub2

Database Title

Additional Information

How to Cite

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. DOI: 10.1002/14651858.CD005005.pub2.

Author Information

  1. 1

    Prince of Wales Hospital, Anaesthesia Department, Randwick, NSW, Australia

  2. 2

    Medical College of Ohio, Dept of Radiation Oncology, Toledo, Ohio, USA

  3. 3

    Virginia Mason Medical Centre, Centre for Hyperbaric Medicine, Seattle, Washington State, USA

  4. 4

    Prince of Wales Hospital, Department of Radiation Oncology, Randwick, NSW, Australia

  5. 5

    Sydney Cancer Centre, Department of Radiation Oncology, Camperdown , NSW, Australia

*Michael H Bennett, Anaesthesia Department, Prince of Wales Hospital, Barker Street, Randwick, NSW, 2031, Australia. m.bennett@unsw.edu.au.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 15 APR 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Cancer is a significant global health problem. Radiotherapy is a treatment for many cancers and about 50% of patients having radiotherapy with be long-term survivors. Some will experience late radiation tissue injury (LRTI) developing months or years later. Hyperbaric oxygen therapy (HBOT) has been suggested as a treatment for LRTI based upon the ability to improve the blood supply to these tissues. It is postulated that HBOT may result in both healing of tissues and the prevention of problems following surgery.

Objectives

To assess the benefits and harms of hyperbaric oxygen therapy for treating or preventing late radiation tissue injury.

Search methods

We searched The Cochrane Central Register of Controlled Trials (CENTRAL Issue 3, 2008), MEDLINE, EMBASE, CINAHL and DORCTHIM (hyperbaric RCT register) from inception to August 2008.

Selection criteria

Randomised controlled trials (RCTs) comparing the effect of HBOT versus no HBOT on LRTI prevention or healing.

Data collection and analysis

Three review authors independently evaluated the quality of the relevant trials using the guidelines of the Cochrane Handbook and extracted the data from the included trials.

Main results

Eight trials contributed to this review (566 participants). For pooled analyses, investigation of heterogeneity suggested important variability between trials. From single studies there was a significantly increased chance of improvement or cure following HBOT for radiation proctitis (relative risk (RR) 1.72, 95% confidence interval (CI) 1.0 to 2.9, P = 0.04, numbers needed to treat (NNT) = 5), and following both surgical flaps (RR 8.7, 95% CI 2.7 to 27.5, P = 0.0002, NNT = 4) and hemimandibulectomy (RR 1.4, 95% CI 1.1 to 1.8, P = 0.001, NNT = 5). There was also a significantly improved probability of healing irradiated tooth sockets following dental extraction (RR 1.4, 95% CI 1.1 to 1.7, P = 0.009, NNT = 4).

There was no evidence of benefit in clinical outcomes with established radiation injury to neural tissue, and no data reported on the use of HBOT to treat other manifestations of LRTI. These trials did not report adverse effects.

Authors' conclusions

These small trials suggest that for people with LRTI affecting tissues of the head, neck, anus and rectum, HBOT is associated with improved outcome. HBOT also appears to reduce the chance of osteoradionecrosis following tooth extraction in an irradiated field. There was no such evidence of any important clinical effect on neurological tissues. The application of HBOT to selected patients and tissues may be justified. Further research is required to establish the optimum patient selection and timing of any therapy. An economic evaluation should be also be undertaken. There is no useful information from this review regarding the efficacy or effectiveness of HBOT for other tissues.

 

Plain language summary

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  2. Abstract
  3. Plain language summary
  4. 摘要

Hyperbaric oxygen (HBO) for the treatment of the late effects of radiation therapy

There is a risk of serious complications developing after radiation treatment for cancer (late radiation tissue injury (LRTI). Hyperbaric oxygen therapy (HBOT) involves breathing oxygen in a specially designed chamber. It is used as a treatment to improve oxygen supply to damaged tissue and stimulate healing.

We found some evidence that 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. Our conclusions are based on eight randomised trials with a limited number of patients. Further research is needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以高壓氧治療延遲性放射性組織損傷

癌症是一個嚴重的全球性健康問題。放射治療是許多癌症的治療方法，而且接受放射治療的病人中，大約50% 的人長時間存活。其中有些病人會在數個月或數年後，發生延遲性放射性組織損傷(late radiation tissue injury，LRTI)。由於高壓氧治療(Hyperbaric oxygen therapy，HBOT)可以改善血液供應至這些組織的情況，所以建議用於治療LRTI。醫學界假設，HBOT可以同時使組織癒合並且預防手術後發生的問題。

目標

評估HBOT治療或預防LRTI的效益及害處。

搜尋策略

我們於2008年8月搜尋了We searched The Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2004, MEDLINE, EMBASE, CINAHL and DORCTHIM (hyperbaric RCT register) in September 2004.

選擇標準

比較以HBOT治療及未以HBOT治療，對於預防或治療LRTI之效果的隨機對照試驗(randomised controlled trials；RCTs)。

資料收集與分析

3名研究回顧者利用Cochrane Handbook指南，獨立地評估相關試驗之品質，並從收納的試驗中摘錄數據。

主要結論

本回顧包含6項試驗(447名參加者)。為了進行合併分析，異質性的調查顯示這些試驗之間存在著很大的變異性。從單一的研究中，觀察到HBOT治療放射性直腸炎後(相對風險(RR)1.72，95% 信賴區間(CI)1到2.9，P = 0.04，需要治療的人數(NNT) = 5)，皮瓣修復手術後接受HBOT治療(RR 8.7，95% CI 2.7到27.5，P = 0.0002，NNT = 4)半下頜切除術後以HBOT治療(RR 1.4，95% CI 1.1到1.8，P = 0.001，NNT = 5)，治癒的機會都明顯增加了。HBOT治癒拔牙後經過放射線照射之齒槽的可能性，也明顯增加了(RR 1.4，95% CI 1.1到1.7，P = 0.009，NNT = 4)。並未發現HBOT治療有益於神經組織放射性損傷之臨床結果的證據，同時也沒有資料提出使用HBOT治療LRTI其他表徵的報告。這些試驗並未提出不良的影響。

作者結論

這些小型試驗建議，對於頭部、頸部、肛門和直腸組織受到LRTI的人而言，HBOT可以改善其結果。HBOT似乎也可以減少經過放射線照射後拔牙而引起的骨壞死。對於神經組織而言，並未發現具有重大臨床效果的證據。針對特定病人和組織使用HBOT，是有正當理由的。還需要進一步研究，以確定最理想的病人挑選標準及治療的時間點。同時也需要進行經濟效益的評估。從這篇回顧中，並未獲得HBOT對於其他組織之效力及效益的有用資訊。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

高壓氧氣(HBO)可能有助於改善頭部、頸部及腸道的放射性損傷。似乎也可以減少拔牙後發生骨壞死的機會。癌症病人接受放射治療後，可能會發生嚴重的併發症(延遲性放射性組織損傷(LRTI))。高壓氧治療(HBOT)的方式，是在一個特殊設計的房間裡呼吸氧氣。它可以當成一種治療方法，用來改善受損組織的氧氣供應及刺激癒合。我們發現了一些證據，證明HBOT可以改善受到LRTI侵犯的頭部、頸部及腸道末端。只有很少量的證據支持或反對HBOT有利於其他受到LRTI影響的組織。我們根據6項病人數量有限的隨機試驗得到上述的結論。建議還需要進一步研究。

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