Hyperbaric oxygen and radiation therapy: a review
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REVIEW ARTICLE
Hyperbaric oxygen and radiation therapy: a review E. Fernández1 · V. Morillo1 · M. Salvador2 · A. Santafé1 · I. Beato1 · M. Rodríguez1 · C. Ferrer1 Received: 17 June 2020 / Accepted: 10 October 2020 © Federación de Sociedades Españolas de Oncología (FESEO) 2020
Abstract About 5% of cancer patients treated with radiotherapy will have severe late-onset toxicity. Hyperbaric oxygen therapy (HBOT) has been used as a treatment for radiation injuries for decades, with many publications presenting data from small series or individual cases. Moreover, we know that the hypoxic areas of tumours are more resistant to radiation. HBOT increases the oxygen tension in tissues and, theoretically, it should enhance the efficiency of radiotherapy. To better understand how HBOT works, we carried out this bibliographic review. We found Grade B and C evidence that at pressures exceeding 2 absolute atmospheres (ata), HBOT reduced late-onset radiation injuries to the head and neck, bone, prostate and bladder. It also appeared to prevent osteoradionecrosis after exodontia in irradiated areas. Finally, HBOT at 2 ata increased the effectiveness of radiation in head and neck tumours and achieved promising results in the local control of high-grade gliomas. Keywords Hyperbaric oxygen therapy · Radiotoxicity · Radio-sensitization · Cancer
The use of hyperbaric oxygen therapy in the treatment of toxicity and radio‑sensitization: myths and realities There are a wide range of situations that can benefit from hyperbaric oxygen therapy (HBOT). The common denominator in all of them is tissue hypoxia in which the oxygen supply or its use is reduced or insufficient. HBOT is a noninvasive technique which aims to achieve high oxygen partial pressures in tissues by allowing the patient breathe pure oxygen at higher than atmospheric pressure inside a pressurized cabin. Depending on the therapeutic intention and the severity of the lesions, HBOT usually uses treatment pressures between 2.0 and 2.5 absolute atmospheres (ata) for periods from 60 to 120 min, once a day for a total of 30–60 sessions. Concurrently, there is ample evidence for the beneficial effects of radiotherapy (RT) in the treatment of malignancies. Physicians are increasingly using more conformed * E. Fernández [email protected] 1
Radiation Oncology Service, Provincial Hospital of Castellón, Avda. Dr. Clara 19, 12002 Castellón de la Plana, Spain
Hyperbaric Therapy Unit, General Hospital of Castellón, Castellón de la Plana, Spain
2
RT techniques such intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT). These therapies allow the delivery of a high dose of RT to a very specific area and limit the irradiation of healthy tissues. However, despite these technological advances, their effectiveness in hypoperfused tissues has not increased. This may be because these tissues contain hypocellular, hypovascular, and hypoxic areas which have lost the capacity for self-repair and have an intrinsic resistance to radiation. HBOT causes a s
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