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Hyperbaric oxygen therapy

BMJ 1999; 318 doi: (Published 17 April 1999) Cite this as: BMJ 1999;318:1076

Combination with radiotherapy in cancer is of proved benefit but rarely used

  1. Charlotte Coles, Specialist registrar in clinical oncology,
  2. Michael William, Clinical director in oncology,
  3. Neil Burnet, Honorary consultant in oncology (
  1. Addenbrooke's Hospital, Oncology Centre, Cambridge CB2 2QQ
  2. Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney, NSW 2031, Australia
  3. St Thomas's Hospital, London SE1 7EH
  4. Royal Shrewsbury Hospital, Shrewsbury SY3 8XF

    EDITOR—Leach et al discuss various clinical applications of hyperbaric oxygen therapy.1 They conclude that the use of hyperbaric oxygen should be evidence based, but their article omits an important and much researched clinical use—combined radiotherapy and hyperbaric oxygen in patients with cancer.

    Hyperbaric oxygen was first used 50 years ago to increase cellular oxygen delivery and thus overcome hypoxia as a cause of tumour radioresistance. The Medical Research Council coordinated several large multicentre trials. Significant benefit was found in both locoregional tumour control and survival in head and neck cancer2 and carcinoma of the uterine cervix.3 A meta-analysis of combined hyperbaric oxygen and radiotherapy reviewed 19 trials in tumours at various sites with a total of 2488 patients.4 Locoregional control with the combined modality was 62%, versus 53% with radiotherapy alone (P<0.0001). Subgroup analysis showed that the greatest improvement in local control and survival occurred in head and neck cancer.

    This scientifically proved application of hyperbaric oxygen is now unused. It was initially hoped that chemical radiosensitisers would substitute for hyperbaric oxygen and so simplify treatment, because animal studies had generated considerable optimism; clinical trials, however, showed only marginal therapeutic gain.

    Other evidence based developments in radiotherapy have not been implemented. Recent trials of altered radiotherapy fractionation have shown increased local control and survival in some tumours. …

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