Hyperbaric oxygen therapy for late radiation tissue injury

BackgroundCancer is a significant global health problem. Radiotherapy is a treatment for many cancers and about 50% of people having radiotherapywill be long-term survivors. Some will experience late radiation tissue injury (LRTI) developing months or years later. Hyperbaric oxygentherapy (HBOT) has been suggested as a treatment for LRTI based upon the ability to improve the blood supply to these tissues. It ispostulated that HBOT may result in both healing of tissues and the prevention of problems following surgery.ObjectivesTo assess the benefits and harms of HBOT for treating or preventing LRTI.Search methodsWe updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 11), MEDLINE, EMBASE, DORCTIHMand reference lists of articles in December 2015. We also searched for ongoing trials at clinicaltrials.gov.Selection criteriaRandomised controlled trials (RCTs) comparing the eBect of HBOT versus no HBOT on LRTI prevention or healing.Data collection and analysisThree review authors independently evaluated the quality of the relevant trials using the guidelines of the Cochrane Handbook forSystematic Reviews of Interventions and extracted the data from the included trials.Main resultsFourteen trials contributed to this review (753 participants). There was some moderate quality evidence that HBOT was more likely toachieve mucosal coverage with osteoradionecrosis (ORN) (risk ratio (RR) 1.3; 95% confidence interval (CI) 1.1 to 1.6, P value = 0.003, numberneeded to treat for an additional beneficial outcome (NNTB) 5; 246 participants, 3 studies). There was also moderate quality evidence ofa significantly improved chance of wound breakdown without HBOT following operative treatment for ORN (RR 4.2; 95% CI 1.1 to 16.8, Pvalue = 0.04, NNTB 4; 264 participants, 2 studies). From single studies there was a significantly increased chance of improvement or curefollowing HBOT for radiation proctitis (RR 1.72; 95% CI 1.0 to 2.9, P value = 0.04, NNTB 5), and following both surgical flaps (RR 8.7; 95%CI 2.7 to 27.5, P value = 0.0002, NNTB 4) and hemimandibulectomy (RR 1.4; 95% CI 1.1 to 1.8, P value = 0.001, NNTB 5). There was also asignificantly improved probability of healing irradiated tooth sockets following dental extraction (RR 1.4; 95% CI 1.1 to 1.7, P value = 0.009,NNTB 4).There was no evidence of benefit in clinical outcomes with established radiation injury to neural tissue, and no randomised data reportedon the use of HBOT to treat other manifestations of LRTI. These trials did not report adverse events

Categories: Odontology, Oncology, Surgery and transplant