A Retrospective Study of Outcomes in Subjects of Head and Neck Cancer Treated with Hyperbaric Oxygen Therapy for Radiation Induced Osteoradionecrosis of Mandible at a Tertiary Care Centre: An Indian Experience

Abstract

Osteoradionecrosis (ORN) of the mandible is a rare complication of radiation therapy for head and neck cancer. It manifests as an area of exposed necrotic bone failing to heal for at least 3 months. Our study aims to determine the effectiveness of HBO in management of radiation induced mandibular ORN. A retrospective study of 33 subjects of mandibular ORN treated with HBOT during period 2009-2011 was carried out. The mean patient age was 60 years (range 41-80).They were treated in a multiplace hyperbaric chamber at 2.4 ATA, for 90 min once a day for up to 30 sessions. Pre and post treatment improvement in relation to symptoms, healing of intraoral wound and overall wellbeing were evaluated. Out of 33 Subjects, 48 % (n = 16) cases showed complete healing of wound, 18 % (n = 6) had marked healing, slight healing in 24 % (n = 8) cases and 9 % (n = 3) cases had no change in healing. 70 % (23 of 33) cases had significant reduction in pain, 62 % (18 of 29) cases had improved jaw opening, 41 % (11 of 27) cases and 71 % (20 of 28) cases showed improvement in ability to talk and mouth dryness respectively. Overall 85 % (28 of 30) cases showed improvement. Our clinical experience supports the efficacy of HBO treatment for radiation induced mandibular ORN and we recommend additional multicentric, prospective studies to be carried out defining the role of HBOT using at least 30 sessions in such cases.

The Enhancing Effects of Hyperbaric Oxygen on Mouse Skin Carcinogenesis

“…HBO has been applied to clinical practice 16 ; however, the effect of HBO on tumors has not been clarified. HBO therapy has been used in clinical medicine in combination with radiotherapy 17 , 18 , 19 or chemotherapy 20 for cancer treatment, but no obvious answer has been reported concerning the efficacy of HBO alone against tumors 21 . In this study, the experiment was designed to examine the effect on tumor cells actually in an environment similar to a living body in a mouse chemical carcinogenesis model.…”

Hyperbaric oxygen treatment of mandibular osteoradionecrosis: Combined data from the two randomized clinical trials DAHANCA-21 and NWHHT2009-1

“…However, the benefit of HBO in mandibular ORN remains controversial because of low evidence. Only one randomised clinical trial (RCT) has been conducted, while several cohort studies of variable quality have been published, reporting ORN recovery rates from zero to 100 percent [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The studies are hardly comparable due to variation in the application of HBO, as well as variability of the study designs, classification, and severity of ORN. Consequently, there has been a need for further investigation of the clinical effect of HBO on ORN.…”

The Use of Hyperbaric Oxygen for the Prevention and Management of Osteoradionecrosis of the Jaw: A Dana-Farber/Brigham and Women’s Cancer Center Multidisciplinary Guideline

“…Since then, several published studies questioned the role of HBO in preventing and managing ORN. However, there is great heterogeneity among the studies, and the results are vastly conflicting from study to study . The only prospective randomized clinical trial on ORN prevention prior to dental extraction(s) demonstrated improved outcomes with HBO prophylaxis compared with antibiotic prophylaxis .…”

“…Retrospective case series with small sample sizes suggest that combining HBO with surgical intervention may be beneficial in the resolution of ORN, but these studies lacked control arms, and the HBO protocols and definitions for ORN varied greatly amongst the studies . The highest level of evidence available to date on the management of ORN using HBO comes from the Annane et al 2004 multicenter trial.…”