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Mezri S, Zitouni C, Bahrini K, Haggui M, Boughzala W, Gharsallah H. Factors influencing osteoradionecrosis progression during hyperbaric oxygen therapy: A case study. F1000Res 2025; 13:1225. [PMID: 39931326 PMCID: PMC11809644 DOI: 10.12688/f1000research.155112.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2024] [Indexed: 02/13/2025] Open
Abstract
Introduction Although relatively uncommon, osteoradionecrosis (ORN) remains a serious complication following radiotherapy. Various therapeutic approaches, including hyperbaric oxygen therapy (HBOT), are utilized in managing ORN. This study aims to evaluate the role of HBOT in ORN management and to identify predictive factors influencing the evolution of head and neck ORN after HBOT. Methods This retrospective study includes 46 patients who received HBOT for head and neck ORN between 2017 and 2020. The patients were divided into two groups: Group 1 (n=36) included those with regression or stabilization of ORN, while Group 2 (n=10) comprised patients with worsening lesions. We performed a statistical study in order to identify factors influencing ORN progression under treatment. Results ORN affected the mandible in 93.5% of patients, the maxilla in 2 cases, and the skull base in 4 cases. All patients received HBOT, with an average of 44.65 sessions. Pre-operative HBOT was administered in 17% of cases, and post-operative HBOT was given in 42% of cases. After at least 20 sessions, ORN regressed in 33% of cases, stabilized in 45%, and worsened in 22%.Analysis of factors influencing ORN progression on the univariate study revealed significant associations with high blood pressure (p=0.046), larger tumor size (p=0.004), advanced tumor stages (p=0.048), mean radiation dose (p=0.002), delays between dental care and radiotherapy (p=0.045), and the location of ORN within the mandible (p=0.049). Additionally, the number of HBOT sessions significantly affected ORN evolution, with more sessions correlating with better outcomes (p=0.001). In the multivariate analysis, variables such as the average interval between dental care and radiotherapy (p=0.043) as well as the number of HBOT sessions (p=0.040) emerged as significant influencers of ORN evolution. Conclusion Our study provides valuable insights into the management of ORN by identifying key predictors that influence the post-therapeutic evolution of head and neck ORN after HBOT.
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Affiliation(s)
- Sameh Mezri
- University of Tunis El Manar, Rommana, Tunis, 1068, Tunisia
- ENT department, Military hospital of Tunis, Montfleury, Tunis, 1008, Tunisia
| | - Chaima Zitouni
- University of Tunis El Manar, Rommana, Tunis, 1068, Tunisia
- ENT department, Military hospital of Tunis, Montfleury, Tunis, 1008, Tunisia
| | - Khadija Bahrini
- University of Tunis El Manar, Rommana, Tunis, 1068, Tunisia
- Research Unit UR17DN05, Military hospital of Tunis, Montfleury, Tunis, 1008, Tunisia
| | - Mounir Haggui
- University of Tunis El Manar, Rommana, Tunis, 1068, Tunisia
- Emergency department, Military hospital of Tunis, Montfleury, Tunis, 1008, Tunisia
| | - Wiem Boughzala
- University of Tunis El Manar, Rommana, Tunis, 1068, Tunisia
- ENT department, Military hospital of Tunis, Montfleury, Tunis, 1008, Tunisia
| | - Hedi Gharsallah
- University of Tunis El Manar, Rommana, Tunis, 1068, Tunisia
- Department of hyperbaric oxygen therapy, Military Hospital of Tunis, Montfleury, Tunis, 1008, Tunisia
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Kosaraju N, Zhang H, Qi S, Chin R, Wang MB. Anterior Skull Base Osteoradionecrosis in the Age of Intensity-Modulated Radiation Therapy: A Case Series. J Neurol Surg Rep 2023; 84:e109-e112. [PMID: 37771656 PMCID: PMC10533358 DOI: 10.1055/a-2164-8637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023] Open
Abstract
Background Despites advances in radiation technology, skull base osteoradionecrosis (ORN) continues to be a rare, devastating, and hard to treat complication of radiotherapy. We present three cases of anterior skull base ORN in a cohort treated with intensity-modulated radiation therapy (IMRT). Case Series Three patients developed anterior skull base ORN after receiving at least one round of IMRT. ORN was diagnosed through either nasal endoscopy or imaging findings. The first was a 59-year-old woman with a sinonasal squamous cell carcinoma. Her chemoradiation history was notable for reirradiation and a high dose of radiation (143.3 Gy). The second was a 55-year-old man with recurrent nasopharyngeal carcinoma, whose history was notable for a high dose of radiation (∼140 Gy) and for being reirradiated. The final patient was a 37-year-old woman with an unremarkable history who received radiotherapy (65.0 Gy) for an esthesioneuroblastoma. One patient was asymptomatic and did not receive ORN-specific therapy. The other two were treated with a combination of medical and surgical intervention with successful short-term outcomes (no evidence of infection). Conclusion Anterior skull base ORN can be treated through conservative and surgical means to achieve successful short-term outcomes. Further investigation of long-term outcomes is warranted.
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Affiliation(s)
- Nikitha Kosaraju
- David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Huan Zhang
- Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, California, United States
| | - Sharon Qi
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California, United States
| | - Robert Chin
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California, United States
| | - Marilene B. Wang
- Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, California, United States
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Klakeel M, Kowalske K. The Role of Hyperbaric Oxygen Therapy for the Treatment of Wounds. Phys Med Rehabil Clin N Am 2022; 33:823-832. [DOI: 10.1016/j.pmr.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Forner LE, Dieleman FJ, Shaw RJ, Kanatas A, Butterworth CJ, Kjeller G, Alsner J, Overgaard J, Hillerup S, Hyldegaard O, Arnell P, von Buchwald C, Kaanders JHAM, Smeele LE, Specht L, Johansen J, Witjes MJH, Merkx MAW, Jansen EC. Hyperbaric oxygen treatment of mandibular osteoradionecrosis: Combined data from the two randomized clinical trials DAHANCA-21 and NWHHT2009-1. Radiother Oncol 2022; 166:137-144. [PMID: 34843843 DOI: 10.1016/j.radonc.2021.11.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/22/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Osteoradionecrosis (ORN) of the mandible is a serious complication of head and neck radiotherapy. This study aims to investigate the effect of hyperbaric oxygen (HBO) treatment on ORN in two randomized, controlled multicentre trials. METHODS AND MATERIALS Patients with ORN with indication for surgical treatment were randomised to either group 1: surgical removal of necrotic mandibular bone supplemented by 30 pre- and 10 postoperative HBO exposures at 243 kPa for 90 min each, or group 2: surgical removal of necrotic bone only. Primary outcome was healing of ORN one year after surgery evaluated by a clinically adjusted version of the Common Toxicity Criteria of Adverse Events (CTCAE) v 3.0. Secondary outcomes included xerostomia, unstimulated and stimulated whole salivation rates, trismus, dysphagia, pain, Activities of Daily Living (ADL) and quality of life according to EORTC. Data were combined from two separate trials. Ninety-seven were enrolled and 65 were eligible for the intent-to-treat analysis. The 33% drop-out was equally distributed between groups. RESULTS In group 1, 70% (21/30) healed compared to 51% (18/35) in group 2. HBO was associated with an increased chance of healing independent of baseline ORN grade or smoking status as well as improved xerostomia, unstimulated whole salivary flow rate, and dysphagia. Due to insufficient recruitment, none of the endpoints reached a statistically significant difference between groups. ADL data could only be obtained from 50 patients. CONCLUSION Hyperbaric oxygen did not significantly improve the healing outcome of osteoradionecrosis after surgical removal of necrotic bone as compared to standard care (70% vs. 51%). This effect is not statistically significant due to the fact that the study was underpowered and is therefore prone to type II error.
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Affiliation(s)
- Lone E Forner
- Department of Oral and Maxillofacial Surgery, Center of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Anaesthesia, Center of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - François J Dieleman
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center, Utrecht, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Center Nijmegen, The Netherlands.
| | - Richard J Shaw
- Department of Head and Neck Surgery, Aintree University Hospital, Liverpool, UK
| | - Anastasios Kanatas
- Oral & Maxillofacial Surgery Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chris J Butterworth
- Maxillofacial Prosthodontics, Department of Maxillofacial Surgery, Aintree University Hospital, Liverpool, UK
| | - Göran Kjeller
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Hillerup
- Department of Oral and Maxillofacial Surgery, Center of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Hyldegaard
- Department of Anaesthesia, Center of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Arnell
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Center Nijmegen, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Max J H Witjes
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center Nijmegen, The Netherlands; Netherlands Comprehensive Cancer Organization Utrecht, The Netherlands
| | - Erik C Jansen
- Department of Anaesthesia, Center of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Leonetti JP, Weishaar JR, Gannon D, Harmon GA, Block A, Anderson DE. Osteoradionecrosis of the skull base. J Neurooncol 2020; 150:477-482. [PMID: 32394326 DOI: 10.1007/s11060-020-03462-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/18/2020] [Indexed: 01/11/2023]
Abstract
Radiation therapy (RT) is often necessary for the treatment of head and neck cancers. Osteoradionecrosis (ORN) is a rare, but potentially serious complication of RT. RT leads to the destruction of vasculature in radiated tissue causing hypoxia and tissue necrosis. ORN can occur in any bone, but bones with naturally poor blood supply appear to be more susceptible. Bones of the skull base are susceptible, with ORN occurring in the anterior, central, and lateral skull base. Risk factors include cancer type and location, radiation dose, and a variety of patient factors. Patients often present with pain, bleeding, and foul odor and are typically found to have exposed and necrotic bone. Treatment options vary depending on the severity, but typically include pentoxifylline and vitamin E as well as surgical debridement, with less evidence supporting hyperbaric oxygen therapy. Recognition and prompt treatment of ORN will allow for improved patient outcomes.
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Affiliation(s)
- John P Leonetti
- Department of Otolaryngology, Head and Neck Surgery, The Loyola Center for Cranial Base Tumors, Loyola University of Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA.
| | - Jeffrey R Weishaar
- Department of Otolaryngology, Head and Neck Surgery, The Loyola Center for Cranial Base Tumors, Loyola University of Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA
| | - David Gannon
- Loyola Stritch School of Medicine, The Loyola Center for Cranial Base Tumors, Loyola University of Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA
| | - Grant A Harmon
- Department of Radiation Oncology, The Loyola Center for Cranial Base Tumors, Loyola University of Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA
| | - Alec Block
- Department of Radiation Oncology, The Loyola Center for Cranial Base Tumors, Loyola University of Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA
| | - Douglas E Anderson
- Department of Neurological Surgery, The Loyola Center for Cranial Base Tumors, Loyola University of Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA
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A contemporary review about the management of radiation-induced hemorrhagic cystitis. Curr Opin Support Palliat Care 2019; 12:344-350. [PMID: 30015689 DOI: 10.1097/spc.0000000000000375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There are various specific therapeutic intervention available to treat hemorrhagic cystitis, once emergency treatment has been carried out. The lack of prospective studies, because of the relative rarity of this condition, makes it difficult to hierarchize the therapeutic sequence. The present review presents and summarizes the literature published on radiation-induced hemorrhagic cystitis from April 2015, date of a precedent exhaustive review, to March 2018. RECENT FINDINGS During our period of interest, 13 clinical studies and two new clinical trials protocols were published. Most of the clinical studies were retrospective and presented data about hyperbaric oxygen (HBO) therapy, comforting its place as a well tolerated and effective first-line treatment. Other studies reported the outcomes of treatments with alum, formalin, silver nitrate, fulguration with laser or definitive surgery. SUMMARY Although authors seem to agree that formalin and surgery have their role as effective but potentially morbid last-line treatments, there is no consensus on primary approach to management of radiation-induced hemorrhagic cystitis beyond symptomatic measures. Several treatments have proven excellent response rates and few side effects. The results of on-going prospective studies on mesenchymal stromal cells or tacrolimus instillations are awaited, but the main discriminating factor to choose between treatments remains local availability.
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Liao J, Wu MJ, Mu YD, Li P, Go J. Impact of Hyperbaric Oxygen on Tissue Healing around Dental Implants in Beagles. Med Sci Monit 2018; 24:8150-8159. [PMID: 30422972 PMCID: PMC6243870 DOI: 10.12659/msm.912784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The impact of hyperbaric oxygen (HBO) on the healing of soft tissues around dental implants was studied in a beagle model. Material/Methods Beagle dogs were randomized to receive implants, followed by postoperative HBO therapy or not (n=10 per group). On postoperative days 3, 7, and 14, tissue specimens were paraffin-embedded and analyzed by hematoxylin-eosin and Masson staining, as well as immunohistochemistry against CD31. Results Scores for inflammation pathology based on hematoxylin-eosin staining and mean optical density of collagen fibers were significantly different between the HBO and control groups on postoperative days 3 and 7 (P<0.05), but not on day 14. Mean optical density due to anti-CD31 staining was significantly higher in the HBO group on postoperative days 3, 7, and 14 (P<0.05). Conclusions These results suggest that HBO may promote early osteogenesis and soft tissue healing after implantation.
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Affiliation(s)
- Juan Liao
- Department of Stomatology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China (mainland)
| | - Meng-Jun Wu
- Department of Anesthesiology, Chengdu Women' and Children's Central Hospital, Chengdu, Sichuan, China (mainland)
| | - Yan-Dong Mu
- Department of Stomatology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China (mainland)
| | - Peng Li
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China (mainland)
| | - Jun Go
- Department of Stomatology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China (mainland)
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Sønstevold T, Johannessen AC, Reed RK, Salvesen GS, Stuhr L. Hyperbaric oxygen treatment did not significantly affect radiation injury in the mandibular area of rats. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:112-119. [PMID: 29248424 DOI: 10.1016/j.oooo.2017.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/11/2017] [Accepted: 10/24/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hyperbaric oxygen therapy (HBOT) has been used to enhance microcirculation and thereby oxygen tension in tissues. The present study aimed to investigate the effect of HBOT on radiation injury in the mandibular area of rats. STUDY DESIGN The left mandibles of rats were irradiated by external radiotherapy (15 Gy every other week for a total of 75 Gy). Four HBOT strategies were used: 2 prophylactic groups receiving HBOT either between each radiation treatment or immediately following terminated radiation treatment, and 2 therapeutic groups receiving HBOT after the latent period of 6 weeks after irradiation either every day (standard HBOT protocol) or 3 days a week for 6 weeks. Tissue samples of the irradiated area were taken from skin, the salivary gland, and the mandible. All tissues were stained with hematoxylin and eosin for morphologic examination. Furthermore, skin samples were stained with CD31 for blood vessel analysis. RESULTS There was no change in blood vessel density or morphology between controls and HBOT tissues after radiation. The dentin of 2 of the 5 rats that received HBOT either normalized or was not affected by irradiation. CONCLUSIONS HBOT did not affect radiation injury of the mandibular area in rats within 12 weeks after irradiation.
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Affiliation(s)
- Tonje Sønstevold
- Department of Biomedicine, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Anne Christine Johannessen
- The Gade Laboratory for Pathology, Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway; Center for Cancer Biomarkers, University of Bergen, Norway
| | - Rolf K Reed
- Department of Biomedicine, Faculty of Medicine and Dentistry, University of Bergen, Norway; Center for Cancer Biomarkers, University of Bergen, Norway
| | - Gerd S Salvesen
- Department of Biomedicine, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Linda Stuhr
- Department of Biomedicine, Faculty of Medicine and Dentistry, University of Bergen, Norway; Center for Cancer Biomarkers, University of Bergen, Norway.
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Abstract
GENERAL PURPOSE To provide information about hyperbaric oxygen therapy (HBOT), its mechanisms, indications and safe applications based on clinical evidence. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Recall the physiology of wound healing and the mechanisms of action of HBOT.2. Identify current applications of HBOT based on clinical evidence as well as its risks and contraindications. ABSTRACT Treating chronic wounds and infections are challenging medical problems worldwide. Hyperbaric oxygen therapy (HBOT), the administration of 100% oxygen at pressures greater than 1.4 atmosphere absolute in a series of treatments, can be used as an adjunctive therapy in many wound care settings because it improves oxygenation and neovascularization and decreases inflammation in chronic wounds. A growing number of studies support the benefits of HBOT for enhancing wound healing and decreasing the likelihood of negative events such as amputation. However, many practitioners are unfamiliar with HBOT. This article provides a general introduction to HBOT, reviews the physiology and mechanisms of behind HBOT, discusses all the indications for HBOT, and explores in-depth the clinical evidence for HBOT in the treatment of arterial insufficiencies, diabetic ulcers, delayed radiation injury, and chronic refractory osteomyelitis.
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Borab Z, Mirmanesh MD, Gantz M, Cusano A, Pu LL. Systematic review of hyperbaric oxygen therapy for the treatment of radiation-induced skin necrosis. J Plast Reconstr Aesthet Surg 2017; 70:529-538. [DOI: 10.1016/j.bjps.2016.11.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/25/2016] [Accepted: 11/30/2016] [Indexed: 01/03/2023]
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Anti-inflammatory effects of hyperbaric oxygen on irradiated laryngeal tissues. Braz J Otorhinolaryngol 2017; 84:206-211. [PMID: 28341337 PMCID: PMC9449171 DOI: 10.1016/j.bjorl.2017.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/05/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION To manage the complications of irradiation of head and neck tissue is a challenging issue for the otolaryngologist. Definitive treatment of these complications is still controversial. Recently, hyperbaric oxygen therapy is promising option for these complications. OBJECTIVE In this study, we used biochemical and histopathological methods to investigate the efficacy of hyperbaric oxygen against the inflammatory effects of radiotherapy in blood and laryngeal tissues when radiotherapy and hyperbaric oxygen are administered on the same day. METHODS Thirty-two Wistar Albino rats were divided into four groups. The control group was given no treatment, the hyperbaric oxygen group was given only hyperbaric oxygen therapy, the radiotherapy group was given only radiotherapy, and the radiotherapy plus hyperbaric oxygen group was given both treatments on the same day. RESULTS Histopathological and biochemical evaluations of specimens were performed. Serum tumor necrosis factor-α, interleukin-1β, and tissue inflammation levels were significantly higher in the radiotherapy group than in the radiotherapy plus hyperbaric oxygen group, whereas interleukin-10 was higher in the radiotherapy plus hyperbaric oxygen group. CONCLUSION When radiotherapy and hyperbaric oxygen are administered on the same day, inflammatory cytokines and tissue inflammation can be reduced in an early period of radiation injury.
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Mühlstädt S, Mohammed N, Weigand K, Schumann A, Kawan F, Göllert C, Fornara P. [Radiation cystitis : Pathophysiology and treatment]. Urologe A 2017; 56:301-305. [PMID: 28127627 DOI: 10.1007/s00120-017-0319-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Radiation cystitis (RC) is a common side-effect of radiation to the pelvis. Their clinical appearance as well as their degree of expression is manifold, as are the therapeutic options. However, in the absence of randomized examinations, recommendations are difficult. We differentiate between oral, systemic therapies, intravesical instillations and interventions as well as interventional, radiological and, as an ultima ratio, surgical treatments. This article provides an overview of the different treatment options with particular emphasis on the conservative-interventional therapy options.
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Affiliation(s)
- S Mühlstädt
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland.
| | - N Mohammed
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland
| | - K Weigand
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland
| | - A Schumann
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland
| | - F Kawan
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland
| | - C Göllert
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland
| | - P Fornara
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland
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Dhanda J, Pasquier D, Newman L, Shaw R. Current Concepts in Osteoradionecrosis after Head and Neck Radiotherapy. Clin Oncol (R Coll Radiol) 2016; 28:459-66. [PMID: 27038708 DOI: 10.1016/j.clon.2016.03.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/01/2016] [Accepted: 03/10/2016] [Indexed: 11/17/2022]
Abstract
Osteoradionecrosis (ORN) of the jaws is a feared complication of head and neck radiotherapy. ORN causes significant morbidity for patients and controversy among clinicians. This overview considers the variations in definition and classification of the condition that affect estimates of incidence and also the interpretation of evidence. The influence of newer radiotherapy techniques in reducing ORN through reduced dose and xerostomia is balanced against a probable increase in a vulnerable population through a rising head and neck cancer incidence. Theories of pathophysiology of ORN include radiation-induced osteomyelitis, hypoxic and hypovascular theory and fibroatrophic theory. Prevention strategies include restorative dentistry and radiation planning techniques. Treatments range from conservative 'watch and wait' through to more radical surgical strategies. Newer medical management strategies are available with a limited evidence base. The use of hyperbaric oxygen therapy remains controversial and the background and need for newer hyperbaric oxygen trials is discussed.
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Affiliation(s)
- J Dhanda
- Department of Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, UK.
| | - D Pasquier
- Academic Department of Radiation Oncology, Centre O. Lambret, Lille, CRIStAL UMR CNRS 9189, France
| | - L Newman
- Department of Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, UK
| | - R Shaw
- Department of Molecular and Clinical Cancer Medicine, North West Cancer Research Centre, The University of Liverpool Cancer Research Centre, Liverpool, UK
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Teguh DN, Raap RB, Struikmans H, van Hulst RA. Hyperbaric oxygen therapy for chronic bowel dysfunction after pelvic radiotherapy. Lancet Oncol 2016; 17:e130-e131. [PMID: 27300667 DOI: 10.1016/s1470-2045(16)00108-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/25/2022]
Affiliation(s)
- David N Teguh
- Hyperbaar Geneeskundig Centrum, 2288 EG Rijswijk, Netherlands; Department of Surgery/Hyperbaric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
| | - René Bol Raap
- Hyperbaar Geneeskundig Centrum, 2288 EG Rijswijk, Netherlands
| | - Henk Struikmans
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, Netherlands; Radiotherapy Centre West, Medical Centre Haaglanden, The Hague, Netherlands
| | - Rob A van Hulst
- Hyperbaar Geneeskundig Centrum, 2288 EG Rijswijk, Netherlands; Department of Anesthesiology/Hyperbaric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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