Hyperbaric oxygen therapy in the treatment of complications of irradiation in head and neck area.

BACKGROUND AND PURPOSE: We have investigated the treatment results of hyperbaric oxygen (HBO2) to patients with radiation-induced tissue complications. MATERIAL AND METHODS: Eight patients (1.4%) from 548 with head and neck cancers treated surgically with post- or preoperative radiotherapy or radiotherapy alone in standard doses who developed postradiation complications (6 patients with laryngeal chondroradionecrosis, 1 patient with osteoradionecrosis of the temporal bone, and 1 patient with soft tissue radionecrosis) are presented. To evaluate radiation reactions occuring in the head and neck region, we used the Chandler grading system for classification of postradiation larynx injuries and SOMA/LENT score for classification of postradiation injuries of mucosa of upper aerodigestive tract. Grades I and II in those grading systems are expected side effects of radiation therapy, thus our cases were all in grades III and IV. The HBO2 was performed after failure of the conventional treatment (antibiotics, steroids, topical therapy). The number of HBO2 expositions was from 8 to 39 and the delay to therapy from 2 to 22 months. RESULTS: Symptoms resolved in all treated patients. Six patients with laryngeal chondroradionecrosis had no symptoms after therapy and in three of them after partial laryngectomy the decannulation was performed. In one patient with mucosal radionecrosis after total laryngectomy, the esophageal fistula was closed and in one patient with osteoradionecrosis of the temporal bone, wound debridement followed. CONCLUSION: The authors' experience supports the increasing clinical evidence that HBO2 is an effective adjunct therapy for treatment of complications of irradiation in head and neck area.

Hyperbaric oxygen in the therapeutic management of osteoradionecrosis of the facial bones.

This paper reviews all 17 cases of facial bone osteoradionecrosis (ORN) which were treated in Adelaide, South Australia, in a nine-year period (1987 1996). This was 1.2% of all cases of head and neck cancer treated with radiotherapy (RT). Fourteen cases received treatment following the Marx principles of staging and the protocols of hyperbaric oxygen plus or minus surgery. The three exclusions were two patients who died of recurrent cancer before treatment was complete and one who declined treatment. The eleven cases of mandibular ORN occurred within a few years of the initial RT treatment. All except one occurred after surgical trauma, with dental extractions being the factor in nine cases. All responded to HBO, with or without surgery depending on stage. The three cases of temporal bone ORN were all of late spontaneous onset. All were stage I and all responded to HBO alone. This study shows that the incidence of ORN in Adelaide is low, probably through use of conservative doses of RT and good preventative protocols. The treatment with HBO plus or minus surgery was effective.