Hyperbaric oxygen as an adjunctive therapy in treatment of malignancies, including brain tumours.

Katarzyna Stępień,Robert P Ostrowski,Ewa Matyja

doi:10.1007/s12032-016-0814-0

Katarzyna Stępień, Robert P Ostrowski + Show 1 more

Open Access

https://doi.org/10.1007/s12032-016-0814-0

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Abstract

Hyperbaric oxygen (HBO) therapy is widely used as an adjunctive treatment for various pathological states, predominantly related to hypoxic and/or ischaemic conditions. It also holds promise as an approach to overcoming the problem of oxygen deficiency in the poorly oxygenated regions of the neoplastic tissue. Occurrence of local hypoxia within the central areas of solid tumours is one of the major issues contributing to ineffective medical treatment. However, in anti-cancer therapy, HBO alone gives a limited curative effect and is typically not applied by itself. More often, HBO is used as an adjuvant treatment along with other therapeutic modalities, such as radio- and chemotherapy. This review outlines the existing data regarding the medical use of HBO in cancer treatment, with a particular focus on the use of HBO in the treatment of brain tumours. We conclude that the administration of HBO can provide many clinical benefits in the treatment of tumours, including management of highly malignant gliomas. Applied immediately before irradiation, it is safe and well tolerated by patients, causing rare and limited side effects. The results obtained with a combination of HBO/radiotherapy protocol proved to be especially favourable compared to radiation treatment alone. HBO can also increase the cytostatic effect of certain drugs, which may render standard chemotherapy more effective. The currently available data support the legitimacy of conducting further research on the use of HBO in the treatment of malignancies.

Highlights

Hyperbaric oxygen (HBO) therapy is the use of oxygen under elevated atmospheric pressure, that is, at a pressure higher than the pressure found on the surface of the earth at sea level, which is defined to be 1 atm [1]
The results suggested that HBO/IAR may be advantageous for patients with poor prognosis, who achieved comparable results to those with good prognosis
The results of this study suggested that the combination of TMZ and HBO significantly diminishes cell proliferation and angiogenesis and that it stimulates apoptosis of glioma cells, in comparison with the control group and the group treated with TMZ alone

Summary

Introduction

Hyperbaric oxygen (HBO) therapy is the use of oxygen under elevated atmospheric pressure, that is, at a pressure higher than the pressure found on the surface of the earth at sea level, which is defined to be 1 atm [1]. Henk et al [38] obtained similar negative results in a clinical trial of head and neck cancer treatment in which HBO was used as a radiosensitizer In this trial, the survival time was similar regardless of whether the patients were breathing oxygen under elevated pressure or normobaric air; local control of the tumour was improved in the HBO-treated group. Henk et al [39] observed a significant improvement in patient survival (60 vs 30 %) and tumour local control (63 vs 30 %) with radiation treatment in HBO or air. Other recent reports suggest that HBO treatment of patients with cancers of the head and neck improves local tumour control and the overall outcome and that the side effects observed previously were caused by excessive radiation doses per fraction [35, 44]. Decreased VEGF and MRP-1 protein levels that were observed in the HBO and TMZ/HBO experimental groups suggested that HBO may elicit its effect through two pathways: inhibition of angiogenesis and diminution of drug resistance

Final conclusions

Findings

Compliance with ethical standards