HYPERBARIC OXYGENATION TREATMENT IN ONCOLOGY

Hyperbaric oxygenation therapy (HBOT) combats hypoxia, a predisposing factor for resistance to conventional cancer therapies. Its use as a sensitizer in conventional therapies has been shown to increase the effectiveness of radiotherapy and decrease mortality in some head and neck tumors and there is ample evidence of its use in radio induced lesions. Moreover, in the treatment of pain, it produces a significant improvement in the quality of life of the cancer patient. There are 7 cases in which HBOT at 1.45 ATA was effective in the treatment of radionecrosis, wounds, oncological pain or general well-being. Additional studies should be performed to verify the incorporation of hyperbaric oxygen into cancer therapeutics.

Clinical case 1

A 66-year-old man with left mandibular osteoradionecrosis with pathological fracture as a result of radiotherapy for squamous cell carcinoma of the tongue. He received 39 sessions (2 times/day) with positive evolution. The disappearance of halitosis and odynophagia was observed during treatment. He is awaiting surgery for microsurgical reconstruction with scapular osteomyocutaneous flap and mandibular reconstruction plate.

Clinical case 2

A 64-year-old woman with squamous cell carcinoma of the maxillary sinus. She received RT-QT treatment reaching a dose of 70 Gy. She finished treatment and 1 year and a half later she started with pain in the gum and left eye associating left facial paralysis compatible with a clinical picture of left upper maxillary radionecrosis. Nuclear magnetic resonance imaging (MRI) and positron emission tomography combined with computed axial tomography (PET-CT) that ruled out relapse of the disease were performed. She received 30 sessions of HBOT (1 session per day) of 90 minutes, reducing pain and swelling of the jaw and face with very good evolution.

Clinical case 3

A 56-year-old woman with stage IV rectal adenocarcinoma, T3N2M1 (hepatic LOE). Radiation therapy was performed at the level of the rectum, a dose of 50.4 Gy. After one year after the treatment with radiotherapy, she presented problems in the surgical wound, in treatment with vacuum-assisted closure. Surgical reintervention and chemotherapy were performed with oxaliplatin and capecitabine with hand-foot syndrome associated with capecitabine. Chemotherapy was implemented as part of the treatment plan as chemotherapy. She consulted for an open wound in sacrum as a result of QT-RT. HBOT was indicated with favorable evolution from the first sessions, and with 60 sessions, the wound was almost closed, but she had to intervene surgically for a fistula that is associated and repaired by plastic surgery. Pending surgery, it is proposed to resume pre- and post-surgical treatment.

Clinical case 4

A 59-year-old man with non-keratinizing carcinoma of cavum diagnosed in 2012 (cT3N2M0), stage IV-A. After this diagnosis, he received 6 cycles of QT based on cisplatin and fluorouracil, 2 of the cycles neoadjuvant and the remaining four after completion of RT on tumor area and bilateral cervical region, reaching the total dose of 70 Gy, in scheme of 5 weekly sessions (Monday-Friday) with fractions of 2Gy / session. The oncological treatment was completed in July 2012, after the same, the patient followed periodic oncological check-ups at his reference hospital in the Medical Oncology and Radiation Therapy services. In May 2017, he suffered an episode of left facial paralysis with aphonia, objecting to an ENT examination, right vocal cord paralysis. In PET-CT performed in October 2017, no signs of local or distant recurrence were evident but two bilateral medial temporal foci of 5 and 15 mm in diameter compatible with radionecrosis were seen. Constant periodic reviews were performed every 3-6 months. In the period between reviews, he debuted with facial paralysis that advanced the planned revision. In PET-CT performed in October 2017, no signs of local or distant recurrence were evident but two bilateral medial temporal foci of 5 and 15 mm in diameter were compatible with bilateral temporal radionecrosis secondary to RT with left facial paralysis and cord paralysis right vocal resistant to corticotherapy. Because it was a bilateral radionecrosis, both sides were altered. After receiving 80 sessions (1 / day) of 60 minutes of HBOT, a significant clinical and radiological improvement was achieved objectified by PET-CT. The patient obtained improvements in mobility, night rest, pain and voice recovery.

Clinical case 5

A 77-year-old man with hematuria due to radiant cystitis as a result of treatment of Gleason 9 prostate adenocarcinoma (5 + 4). Radiation therapy, IMRT 76 Gy modality, was indicated. Due to hematuria, pain, asthenia due to radiant cystitis he received 80 sessions of HBOT and after 30 sessions hematuria and pain ceased. He improved his mobility and was incorporated only from the stretcher, disappearing pain, fatigue, and chronic fatigue.

Clinical case 6

A 47-year-old woman with infiltrating ductal breast carcinoma who received conservative treatment, performed surgery and then radiation therapy on a surgical bed. It was an M0M0 pT1b with estrogen and progesterone positive receptors in 90, 95%, ki67 9% in the initial stage. She received 50 Gy radiotherapy in 25 sessions in the bed of the lumpectomy and the breast and began with hormonal treatment with tamoxifen. She consulted the hyperbaric medicine center for generalized muscle and joint pain of great intensity, so she received 60 sessions of HBOT 60 minutes (4 times/week) with positive evolution. At the beginning of treatment, the general condition improved, there was a decrease in pain to mild. At the end of his treatment, she improved her general condition, notable relief of joint and muscle aches that have virtually disappeared. She is at a maintenance/wellness plan.

Clinical case 7

A 60-year-old man with pancreatic head adenocarcinoma. He has treated with surgery + adjuvant QT (gemcitabine), receiving 60 60-minute sessions of HBOT 2-3 times a week. At the beginning of treatment, he referred to asthenia, chronic fatigue, lack of appetite and diffuse and nonspecific and severe abdominal pain, of an analog visual scale (VAS). Although no records of quality of life were taken, the patient’s assessment is that the treatment significantly improved his quality of life.

Conclusion

Hyperbaric oxygenation is an emerging treatment in cancer patients because it is a useful tool for healing and repair of tissues damaged by therapy. Hyperbaric oxygen produces hyperoxia that is a hypoxia modifier and has an analgesic action. Although randomized clinical trials are required to confirm its efficacy and potential applications, the combination of physiological effects resulting from the generation of hyperoxia could help doctors improve the effectiveness of conventional therapy and improve the quality of life of the stage post-cancer treatment.

Authors

Elías López1, Delfina Romero-Feris2.

1 Oncology service, Hospital La Milagrosa, Madrid Spain,

2 BioBarica, Spain

Full article on page 92: https://s3-sa-east-1.amazonaws.com/aaoc.org.ar/uploads/registros/docs/revista_oncologia_clinica_-_vol.24_-_n3_-_2019_-_version_final.pdf

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