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. 2023 Aug 15;8(8):CD005005.
doi: 10.1002/14651858.CD005005.pub5.

Hyperbaric oxygen therapy for late radiation tissue injury

Zhiliang Caleb Lin  1 , Michael H Bennett  2   3 , Glen C Hawkins  4 , Charles Paul Azzopardi  5 , John Feldmeier  6 , Robert Smee  7 , Christopher Milross  8
Affiliations

Hyperbaric oxygen therapy for late radiation tissue injury

Zhiliang Caleb Lin et al. Cochrane Database Syst Rev. .

Abstract

Background: This is the third update of the original Cochrane Review published in July 2005 and updated previously in 2012 and 2016. Cancer is a significant global health issue. Radiotherapy is a treatment modality for many malignancies, and about 50% of people having radiotherapy will be long-term survivors. Some will experience late radiation tissue injury (LRTI), developing months or years following radiotherapy. Hyperbaric oxygen therapy (HBOT) has been suggested as a treatment for LRTI based on the ability to improve the blood supply to these tissues. It is postulated that HBOT may result in both healing of tissues and the prevention of complications following surgery and radiotherapy.

Objectives: To evaluate the benefits and harms of hyperbaric oxygen therapy (HBOT) for treating or preventing late radiation tissue injury (LRTI) compared to regimens that excluded HBOT.

Search methods: We used standard, extensive Cochrane search methods. The latest search date was 24 January 2022.

Selection criteria: We included randomised controlled trials (RCTs) comparing the effect of HBOT versus no HBOT on LRTI prevention or healing.

Data collection and analysis: We used standard Cochrane methods. Our primary outcomes were 1. survival from time of randomisation to death from any cause; 2. complete or substantial resolution of clinical problem; 3. site-specific outcomes; and 4.

Adverse events: Our secondary outcomes were 5. resolution of pain; 6. improvement in quality of life, function, or both; and 7. site-specific outcomes. We used GRADE to assess certainty of evidence.

Main results: Eighteen studies contributed to this review (1071 participants) with publications ranging from 1985 to 2022. We added four new studies to this updated review and evidence for the treatment of radiation proctitis, radiation cystitis, and the prevention and treatment of osteoradionecrosis (ORN). HBOT may not prevent death at one year (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.47 to 1.83; I2 = 0%; 3 RCTs, 166 participants; low-certainty evidence). There is some evidence that HBOT may result in complete resolution or provide significant improvement of LRTI (RR 1.39, 95% CI 1.02 to 1.89; I2 = 64%; 5 RCTs, 468 participants; low-certainty evidence) and HBOT may result in a large reduction in wound dehiscence following head and neck soft tissue surgery (RR 0.24, 95% CI 0.06 to 0.94; I2 = 70%; 2 RCTs, 264 participants; low-certainty evidence). In addition, pain scores in ORN improve slightly after HBOT at 12 months (mean difference (MD) -10.72, 95% CI -18.97 to -2.47; I2 = 40%; 2 RCTs, 157 participants; moderate-certainty evidence). Regarding adverse events, HBOT results in a higher risk of a reduction in visual acuity (RR 4.03, 95% CI 1.65 to 9.84; 5 RCTs, 438 participants; high-certainty evidence). There was a risk of ear barotrauma in people receiving HBOT when no sham pressurisation was used for the control group (RR 9.08, 95% CI 2.21 to 37.26; I2 = 0%; 4 RCTs, 357 participants; high-certainty evidence), but no such increase when a sham pressurisation was employed (RR 1.07, 95% CI 0.52 to 2.21; I2 = 74%; 2 RCTs, 158 participants; high-certainty evidence).

Authors' conclusions: These small studies suggest that for people with LRTI affecting tissues of the head, neck, bladder and rectum, HBOT may be associated with improved outcomes (low- to moderate-certainty evidence). HBOT may also result in a reduced risk of wound dehiscence and a modest reduction in pain following head and neck irradiation. However, HBOT is unlikely to influence the risk of death in the short term. HBOT also carries a risk of adverse events, including an increased risk of a reduction in visual acuity (usually temporary) and of ear barotrauma on compression. Hence, the application of HBOT to selected participants may be justified. The small number of studies and participants, and the methodological and reporting inadequacies of some of the primary studies included in this review demand a cautious interpretation. More information is required on the subset of disease severity and tissue type affected that is most likely to benefit from this therapy, the time for which we can expect any benefits to persist and the most appropriate oxygen dose. Further research is required to establish the optimum participant selection and timing of any therapy. An economic evaluation should also be undertaken.

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Conflict of interest statement

ZCL: none. ZCL is a trainee in diving, hyperbaric and emergency medicine.

MB: none. MB is a hyperbaric physician who regularly treats people with LRTI.

GCH: none. GCH is a hyperbaric physician who regularly treats people with LRTI.

CPA: none. CPA is a hyperbaric physician who regularly treats people with LRTI.

JF: none. JF has previous hyperbaric experience and is a radiation oncologist who refers people with LRTI for HBOT.

RS: none. RS is a radiation oncologist who refers people with LRTI for HBOT.

CM: none. CM is a radiation oncologist who refers people with LRTI for HBOT.

Figures

1
1
Study flow diagram.
2
2
Summary of risk of bias in eight domains in the included studies
3
3
1.1
1.1. Analysis
Comparison 1: Death, Outcome 1: Death at 1 year
2.1
2.1. Analysis
Comparison 2: Complete resolution or significant improvement of problem, Outcome 1: Complete or significant improvement
2.2
2.2. Analysis
Comparison 2: Complete resolution or significant improvement of problem, Outcome 2: Complete or significant improvement (removal of non‐equivalent comparator)
2.3
2.3. Analysis
Comparison 2: Complete resolution or significant improvement of problem, Outcome 3: Sensitivity analysis for missing data – best case
2.4
2.4. Analysis
Comparison 2: Complete resolution or significant improvement of problem, Outcome 4: Sensitivity analysis for missing data – worst case
3.1
3.1. Analysis
Comparison 3: Resolution of pain, Outcome 1: Pain score change at 12 months
4.1
4.1. Analysis
Comparison 4: Osteoradionecrosis (ORN), Outcome 1: Complete resolution or significant improvement
5.1
5.1. Analysis
Comparison 5: Head and neck soft tissues, Outcome 1: Wound dehiscence
6.1
6.1. Analysis
Comparison 6: Radiation cystitis, Outcome 1: Complete resolution or substantial improvement in condition
7.1
7.1. Analysis
Comparison 7: Adverse events, Outcome 1: Reduction in visual acuity
7.2
7.2. Analysis
Comparison 7: Adverse events, Outcome 2: Ear barotrauma
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Annane 2004 {published data only (unpublished sought but not used)}
    1. Annane D, Depondt J, Aubert P, Villart M, Gehanno P, Gajdos P, et al. Hyperbaric oxygen therapy for radionecrosis of the jaw: a randomized, placebo-controlled, double-blind trial from the ORN96 Study Group. Journal of Clinical Oncology 2004;22(24):4893-900. - PubMed
Clarke 2008 {published data only (unpublished sought but not used)}
    1. Clarke D, Tenorio C, Dominguez L, Toklu A, Hussey J. Treatment of radiation necrosis with hyperbaric oxygen: a randomized double-blind placebo controlled trial. Undersea and Hyperbaric Medicine 2004;31:Suppl.
    1. Clarke RE, Catalina Tenorio LM, Hussey JR, Toklu AS, Cone DL, Hinojosa JG, et al. Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a randomised and controlled double-blind crossover trial with long-term follow-up. International Journal of Radiation Oncology, Biology, Physics 2008;72:134-43. - PubMed
Forner 2022 {published and unpublished data}
    1. Forner LE, Dieleman FJ, Shaw RJ, Kanatas A, Butterworth CJ, Kjeller G, et al. Hyperbaric oxygen treatment of mandibular osteoradionecrosis: combined data from the two randomized clinical trials DAHANCA-21 and NWHHT2009-1. Radiotherapy and Oncology 2022;166:137-44. [DOI: 10.1016/j.radonc.2021.11.021] - DOI - PubMed
Glover 2016 {published data only}
    1. Glover M, Smerdon GR, Andreyev HJ, Benton BE, Bothma P, Firth O, et al. Hyperbaric oxygen for patients with chronic bowel dysfunction after pelvic radiotherapy (HOT2): a randomised, double-blind, sham-controlled phase 3 trial. Lancet Oncology 2016;17:P224-33. - PMC - PubMed
Gothard 2010 {published data only}
    1. Gothard L, Haviland J, Bryson P, Laden G, Glover M, Harrison S, et al. Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema after radiotherapy for cancer. Radiotherapy and Oncology 2010;97(1):101-7. [DOI: 10.1016/j.radonc.2010.04.026] - DOI - PubMed
Hulshof 2002 {published data only}
    1. Hulshof M, Stark N, Kleij A, Sminia P, Smeding H, Gonzales D. Hyperbaric oxygen therapy for cognitive disorders after irradiation of the brain. Strahlentherapie und Onkologie 2002;178(4):192-8. [DOI: 10.1007/s00066-002-0916-9] [MEDLINE: ] - DOI - PubMed
Marx 1985 {published data only}
    1. Marx R, Johnson R, Kline S. Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin. Journal of the American Dental Association 1985;111(1):49-54. [MEDLINE: ] - PubMed
Marx 1999a {published data only}
    1. Marx R. Bony reconstruction of the jaw. In: Kindwall EP, Whelan HT, editors(s). Hyperbaric Medicine Practice. 2nd edition. Flagstaff (AZ): Best Publishing Company, 1999:460-3. [MEDLINE: ]
Marx 1999b {published data only}
    1. Marx RE. Soft tissue flaps. In: Kindwall EP, Whelan HT, editors(s). Hyperbaric Medicine Practice. 2nd edition. Flagstaff (AZ): Best Publishing Company, 1999:464-8. [0-941332-78-0]
Oscarsson 2019 {published data only}
    1. Oscarsson N, Muller B, Rosen A, Lodding P, Molne J, Giglio D, et al. Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial. Lancet Oncology 2019;20:1602-14. [DOI: 10.1016/S1470-2045(19)30494-2] - DOI - PubMed
Oton Sanchez 2013 {published data only}
    1. Oton Sanchez C, Gonzalez Lugo Y, Oton Sanchez L, Diaz-flores Varela L, Jimenez Calero J, Puerto Romero P. Treatment of radiation-induced cervical fibrosis with pentoxifylline-tocoferol and hyperbaric oxygen. Reports of Practical Oncology and Radiotherapy 2013;18(S1):S111. [DOI: 10.1016/j.rpor.2013.03.842] - DOI
Pritchard 2001 {published data only}
    1. Pritchard J, Anand P, Broome J, Davis C, Gothard L, Hall E, et al. Double-blind randomized phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiotherapy and Oncology 2001;58(3):279-86. [DOI: 10.1016/s0167-8140(00)00319-4] [MEDLINE: ] - DOI - PubMed
    1. Yarnold J. Double-blind randomised phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiotherapy and Oncology 2005;77(3):327. - PubMed
Schoen 2007 {published data only}
    1. Schoen PJ, Raghoebar GM, Bouma JA, Reintsema HA, Vissink AA, Sterk WA, et al. Rehabilitation of oral function in head and neck cancer patients after radiotherapy with implant-retained dentures: effects of hyperbaric oxygen therapy. Oral Oncology 2007;43(4):379-88. [DOI: 10.1016/j.oraloncology.2006.04.009] - DOI - PubMed
Shao 2011 {published data only}
    1. Shao Y, Lu G-L, Shen Z-J. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis. BJU International 2011;109:691-4. [DOI: 10.1111/j.1464-410X.2011.10550.x] - DOI - PubMed
Shaw 2019 {published data only}
    1. Shaw R, Butterworth C, Tesfaye B, Bickerstaff M, Dodd S, Smerdon G, et al. HOPON (Hyperbaric Oxygen for the Prevention of Osteoradionecrosis): a randomised controlled trial of hyperbaric oxygen to prevent osteoradionecrosis of the irradiated mandible: study protocol for a randomised controlled trial. Trials 2018;19:22. [DOI: 10.1186/s13063-017-2376-7] - DOI - PMC - PubMed
    1. Shaw RJ, Butterworth CJ, Silcocks P, Tesfaye BT, Bickerstaff M, Jackson R, et al. HOPON (Hyperbaric Oxygen for the Prevention of Osteoradionecrosis): a randomized controlled trial of hyperbaric oxygen to prevent osteoradionecrosis of the irradiated mandible after dentoalveolar surgery. International Journal of Radiation Oncology 2019;104(3):530-9. - PubMed
Sidik 2007 {published data only}
    1. Sidik S, Daldiyono H, Setiabudy R, Gondowiardjo S, Yuwono V. Oxygen hyperbaric therapy in patients with radiation proctitis. Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy 2007;8(1):1-4. [DOI: 10.24871/8120071-4] - DOI
    1. Sidik S, Daldiyono H, Setiabudy R, Gondowiardjo S. Does hyperbaric oxygen administration decrease side effects and improve quality of life after pelvic irradiation? Acta Medica Indonesiana 2007;39(4):169-73. - PubMed
Svalestad 2014 {published data only}
    1. Svalestad J, Hellem S, Thorsen E, Johannessen AC. Effect of hyperbaric oxygen treatment on irradiated oral mucosa: microvessel density. International Journal of Oral and Maxillofacial Surgery 2015;44:301-7. - PubMed
    1. Svalestad J, Thorsen E, Vaagbø G, Hellem S. Effect of hyperbaric oxygen treatment on oxygen tension and vascular capacity in irradiated skin and mucosa. International Journal of Oral and Maxillofacial Surgery 2014;43:107-12. [DOI: 10.1016/j.ijom.2013.07.006] - DOI - PubMed
Teguh 2009 {published data only}
    1. Teguh DN, Levendag PC, Noever I, Voet P, Est H, Rooij P, et al. Early hyperbaric oxygen therapy for reducing radiotherapy side effects: early results of a randomized trial in oropharyngeal and nasopharyngeal cancer. International Journal of Radiation Oncology, Biology, Physics 2009;75(3):711-6. [DOI: 10.1016/j.ijrobp.2008.11.056] - DOI - PubMed

References to studies excluded from this review

Carl 2001 {published data only}
    1. Carl U, Feldmeier J, Schmitt G, Hartmann K. Hyperbaric oxygen therapy for late sequelae in women receiving radiation after breast-conserving surgery. International Journal of Radiation Oncology Biology and Physics 2001;49(4):1029-31. [MEDLINE: ] - PubMed
Coulthard 2002 {published data only}
    1. Coulthard P, Esposito M, Worthington H, Jokstad A. Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No: CD003603. [DOI: 10.1002/14651858.CD003603] - DOI - PubMed
Craighead 2011 {published data only}
    1. Craighead, P, Shea-Budgell MA, Nation J, Esmail R, Evans AW, Parliament M, et al. Hyperbaric oxygen therapy for late radiation tissue injury in gynecologic malignancies. Current Oncology 2011;18(5):220. - PMC - PubMed
Denton 2002 {published data only}
    1. Denton A, Forbes A, Andreyev J, Maher E. Non surgical interventions for late radiation proctitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No: CD003455. [DOI: 10.1002/14651858.CD003455] - DOI - PubMed
Gal 2003 {published data only}
    1. Gal T, Yueh B, Futran N. Influence of prior hyperbaric oxygen therapy in complications following microvascular reconstruction for advanced osteoradionecrosis. Archives of Otolaryngology – Head & Neck Surgery 2003;129(1):72-6. [MEDLINE: ] - PubMed
Granstrom 1999 {published data only}
    1. Granstrom G, Tjellstrom A, Branemark P-I. Osseointegrated implants in irradiated bone: a case-controlled study using adjunctive hyperbaric oxygen therapy. Journal of Oral and Maxillofacial Surgery 1999;57:493-9. [0278-2391] - PubMed
Maier 2000 {published data only}
    1. Maier A, Gaggl A, Klemen H, Santler G, Anegg U, Fell B, et al. Review of severe osteoradionecrosis treated by surgery alone or surgery with postoperative hyperbaric oxygenation. British Journal of Oral and Maxillofacial Surgery 2000;38(3):173-6. [MEDLINE: ] - PubMed
Marson 2014 {published data only}
    1. Marson F, Tienforte D, Kocjancic E. Post-radiation cystitis: current treatments. Current Bladder Dysfunction Reports 2014;9(3):156-60.
Niimi 1997 {published data only}
    1. Niimi A, Fujimoto T, Nosaka Y, Ueda M. A Japanese multicenter study of osseointegrated implants placed in irradiated tissues: a preliminary report. International Journal of Oral and Maxillofacial Implants 1997;12(2):259-64. [MEDLINE: ] - PubMed
Rajaganapathy 2014 {published data only}
    1. Rajaganapathy BR, Jayabalan N, Tyagi P, Kaufman J, Chancellor MB. Advances in therapeutic development for radiation cystitis. LUTS: Lower Urinary Tract Symptoms 2014;6(1):1-10. - PubMed
Song 2018 {published data only}
    1. Song KX, Liu S, Zhang MZ, Liang WZ, Liu H, Dong XH, et al. Hyperbaric oxygen therapy improves the effect of keloid surgery and radiotherapy by reducing the recurrence rate. Journal of Zhejiang University 2018;19(11):853-62. - PMC - PubMed
Tobey 1979 {published data only}
    1. Tobey R, Kelly J. Osteoradionecrosis of the jaws. Otolaryngology Clinics of North America 1979;12(1):183-6. [MEDLINE: ] - PubMed

References to ongoing studies

Batenburg 2020 {published data only}
    1. Batenburg MC, den Bongard HJ, Kleynen CE, Maarse W, Witkamp A, Ernst M, et al. Assessing the effect of hyperbaric oxygen therapy in breast cancer patients with late radiation toxicity (HONEY trial): a trial protocol using a trial within a cohort design. Trials 2020;21:980. - PMC - PubMed
Bulsara 2019 {published data only}
    1. Bulsara VM, Bulsara MK, Lewis E. Protocol for prospective randomised assessor-blinded pilot study comparing hyperbaric oxygen therapy with PENtoxifylline+TOcopherol± CLOdronate for the management of early osteoradionecrosis of the mandible. BMJ Open 2019;9(3):e026662. - PMC - PubMed
NCT00087815 {unpublished data only}
    1. NCT00087815. Hyperbaric oxygen therapy in treating patients with radiation necrosis of the brain. clinicaltrials.gov/study/NCT00087815 (first received 14 July 2004).
NCT02714465 {unpublished data only}
    1. NCT02714465. Adverse radiation effects after gamma knife radio surgery and hyperbaric oxygen therapy (GKSHBO). clinicaltrials.gov/study/NCT02714465 (first received 1 March 2016).
NCT03144206 {unpublished data only}
    1. NCT03144206. Evaluation of hyperbaric oxygen therapy on wound healing following management of soft tissue sarcoma with neo-adjuvant radiation and surgical resection. clinicaltrials.gov/study/NCT03144206 (first received 3 May 2017).
NCT03916068 {unpublished data only}
    1. NCT03916068. Acute post-radiation hyperbaric oxygen (HBO2) for breast cancer patients who have recently completed radiation therapy. clinicaltrials.gov/study/NCT03916068 (first received 4 April 2019).
NCT04934644 {unpublished data only}
    1. NCT04934644. The effect of hyperbaric oxygen treatment in patients with osteoradionecrosis. clinicaltrials.gov/study/NCT04934644 (first received 17 May 2021).

Additional references

ACS 2023
    1. American Cancer Society. Cancer facts and figures 2021. www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures... (accessed 3 February 2023).
Baskar 2012
    1. Baskar R, Lee KA, Yeo R, Yeoh KW. Cancer and radiation therapy: current advances and future directions. International Journal of Medical Science 2012;9(3):193-99. [DOI: 10.7150/ijms.3635] [PMID: ] - DOI - PMC - PubMed
Bennett 2011
    1. Bennett M, Connor D. The database of randomised controlled trials in hyperbaric medicine. hboevidence.wikis.unsw.edu.au/ (accessed 23 June 2023).
Bennett 2019
    1. Bennett MH, Hui CF, See HG, Au-Yeung KL, Tan C, Watson S. The myopic shift associated with hyperbaric oxygen administration is reduced when using a mask delivery system compared to a hood – a randomised controlled trial. Diving and Hyperbaric Medicine 2019;49(4):245-52. [DOI: 10.28920/dhm49.4.245-252] - DOI - PMC - PubMed
Borab 2017
    1. Borab Z, Mirmanesh MD, Gantz M, Cusano A, Pu LL. Systematic review of hyperbaric oxygen therapy for the treatment of radiation-induced skin necrosis. Journal of Plastic, Reconstructive & Aesthetic Surgery 2017;70(4):529-38. [DOI: 10.1016/j.bjps.2016.11.024] - DOI - PubMed
Camporesi 2014
    1. Camporesi EM, Bosco G. Mechanisms of action of hyperbaric oxygen therapy. Undersea & Hyperbaric Medicine 2014;41(3):247-52. - PubMed
Cardinal 2018
    1. Cardinal J, Slade A, McFarland M, Keihani S, Hotaling JN, Myers JB. Scoping review and meta-analysis of hyperbaric oxygen therapy for radiation-induced hemorrhagic cystitis. Current Urology Reports 2018;19(38):1-8. - PubMed
CEBM 2004 [Computer program]
    1. CATmaker. Badenoch D, Sackett D, Straus S, Ball C, Dawes M, Version 1.1. Oxford (UK): Centre for Evidence Based Medicine, 2004.
Citrin 2010
    1. Citrin D, Cotrim AP, Hyodo F, Baum BJ, Krishna MC, Mitchell JB. Radioprotectors and mitigators of radiation-induced normal tissue injury. Oncologist 2010;15(4):360-71. - PMC - PubMed
Dalsania 2021
    1. Dalsania RM, Shah KP, Stotsky-Himelfarb E, Hoffe S, Willingham FF. Management of long-term toxicity from pelvic radiation therapy. In: American Society of Clinical Oncology Educational Book. Vol. 41. American Society for Clinical Oncology, 2021:147-57. - PubMed
Drezner 2016
    1. Drezner N, Hardy KK, Wells E, Vezina G, Ho CY, Packer RJ, et al. Treatment of pediatric cerebral radiation necrosis: a systematic review. Journal of Neuro-Oncology 2016;130:141-8. [DOI: 10.1007/s11060-016-2219-5] - DOI - PubMed
Feldmeier 1995
    1. Feldmeier JJ, Heimbach RD, Davolt DA, Court WS, Stegmann BJ, Sheffield PJ. Hyperbaric oxygen as an adjunctive treatment for delayed radiation injury of the chest wall: a retrospective review of twenty-three cases. Undersea and Hyperbaric Medicine 1995;22(4):383-93. [MEDLINE: ] - PubMed
Feldmeier 1998
    1. Feldmeier JJ, Davolt DA, Court WS, Onoda JM, Alecu R. Histologic morphometry confirms a prophylactic effect for hyperbaric oxygen in the prevention of delayed radiation enteropathy. Undersea and Hyperbaric Medicine 1998;25(2):93-7. [MEDLINE: ] - PubMed
Feldmeier 2002
    1. Feldmeier JJ, Hampson NB. A systematic review of the literature reporting the application of hyperbaric oxygen prevention and treatment of delayed radiation injuries: an evidence based approach. Undersea and Hyperbaric Medicine 2002;29(1):4-30. [MEDLINE: ] - PubMed
Feldmeier 2003
    1. Feldmeier J, Carl U, Hartmann K, Sminia P. Hyperbaric oxygen: does it promote growth or recurrence of malignancy? Undersea and Hyperbaric Medicine 2003;30(1):1-18. [MEDLINE: ] - PubMed
Feldmeier 2012
    1. Feldmeier JJ. Hyperbaric oxygen therapy and delayed radiation injuries (soft tissue and bony necrosis): 2012 update. Undersea and Hyperbaric Medicine 2012;39(6):1121-39. - PubMed
Flannigan 2014
    1. Flannigan RK, Baverstock RJ. Management of post-radiation therapy complications among prostate cancer patients: a case series. Canadian Urological Association Journal 2014;8(9-10):E632. - PMC - PubMed
Fox 2015
    1. Fox NF, Xiao C, Sood AJ, Lovelace TL, Nguyen SA, Sharma A, et al. Hyperbaric oxygen therapy for the treatment of radiation-induced xerostomia: a systematic review. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 2015;120(1):22-8. - PubMed
Hadanny 2020
    1. Hadanny A, Efrati S. The hyperoxic–hypoxic paradox. Biomolecules 2020;10(6):958. - PMC - PubMed
Hampson 2012
    1. Hampson NB, Holm JR, Wreford-Brown CE, Feldmeier J. Prospective assessment of outcomes in 411 patients treated with hyperbaric oxygen for chronic radiation tissue injury. Cancer 2012;118:3860-8. - PubMed
Helmers 2022
    1. Helmers R, Milstein DM, Straat NF, Navran A, Teguh DN, Hulst RA, et al. The impact of hyperbaric oxygen therapy on late irradiation injury in oral microcirculation. Head & Neck 2022;44(7):1646-54. [DOI: 10.1002/hed.27073] - DOI - PMC - PubMed
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from training.cochrane.org/handbook/archive/v5.1/.
Higgins 2021
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s) Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane, 2021. training.cochrane.org/handbook/archive/v6.2.
Hills 1999
    1. Hills BA. A role for oxygen-induced osmosis in hyperbaric oxygen therapy. Medical Hypotheses 1999;52:259-63. - PubMed
Hoggan 2014
    1. Hoggan BL, Cameron AL. Systematic review of hyperbaric oxygen therapy for the treatment of non-neurological soft tissue radiation-related injuries. Supportive Care in Cancer 2014;22(6):1715-26. - PubMed
IARC 2020
    1. The Global Cancer Observatory. All cancers fact sheet. gco.iarc.fr/today/data/factsheets/cancers/39-All-cancers-fact-sheet.pdf (accessed 4 October 2021).
Jain 2017
    1. Jain KK. Textbook of Hyperbaric Medicine. Sixth edition. Basel (Switzerland): Springer International Publishing AG, 2017.
Jokinen‐Gordon 2017
    1. Jokinen-Gordon H, Barry R, Watson B, Covington D. A retrospective analysis of adverse events in hyperbaric oxygen therapy (2012–2015): lessons learned from 1.5 million treatments. Advances in Skin & Wound Care 2017;30(3):125-9. [DOI: 10.1097/01.ASW.0000508712.86959.c9.] - DOI - PubMed
Mainous 1975
    1. Mainous EG, Hart GB. Osteoradionecrosis of the mandible. Treatment with hyperbaric oxygen. Archives of Otolaryngology 1975;101(3):173-7. [MEDLINE: ] - PubMed
Majeed 2022
    1. Majeed H, Gupta V. Adverse Effects of Radiation Therapy. Treasure Island (FL): StatPearls Publishing, 2021. - PubMed
Marx 1983
    1. Marx RE. A new concept in the treatment of osteoradionecrosis. Journal of Oral and Maxillofacial Surgery 1983;41:351-7. - PubMed
Marx 1988
    1. Marx RE, Johnson RP. Problem wounds in oral and maxillo-facial surgery: the role of hyperbaric oxygen. In: Davis JC, Hunt TK, editors(s). Problem Wounds: the Role of Oxygen. New York (NY): Elsevier, 1988:65-123.
Marx 1990
    1. Marx RE, Ehler WJ, Tayapongsak P. Relationship of oxygen dose to angiogenesis induction in irradiated tissue. American Journal of Surgery 1990;160:519-24. - PubMed
Mathieu 2006
    1. Mathieu D. Handbook on Hyperbaric Medicine. 1st edition. Dordrecht (the Netherlands): Springer, 2006.
Neuman 2008
    1. Neuman T, Thom S. Physiology and Medicine of Hyperbaric Oxygen Therapy. 1st edition. Philadelphia (PA): Saunders, 2008.
Parmar 1998
    1. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analysis of the published literature for survival endpoints. Statistics in Medicine 1998;17:2815-34. - PubMed
Ravi 2017
    1. Ravi P, Vaishnavi D, Gnanam A, Raja VB. The role of hyperbaric oxygen therapy in the prevention and management of radiation-induced complications of the head and neck – a systematic review of literature. Journal of Stomatology, Oral and Maxillofacial Surgery 2017;118(6):359-62. - PubMed
RevMan 2020 [Computer program]
    1. Review Manager (RevMan). Version 5.4. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2020.
Schünemann 2013
    1. Schünemann H, Brożek J, Guyatt G, Oxman A, editor(s). Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach (updated October 2013). GRADE Working Group, 2013. Available from gdt.guidelinedevelopment.org/app/handbook/handbook.html.
Shah 2017
    1. Shah DN, Chauhan CJ, Solanki JS. Effectiveness of hyperbaric oxygen therapy in irradiated maxillofacial dental implant patients: a systematic review with meta-analysis. Journal of Indian Prosthodontic Society 2017;17(2):109-19. [DOI: ] - PMC - PubMed
Stone 2003
    1. Stone HB, Coleman CN, Anscher MS, McBride WH. Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncology 2003;4(9):529-36. [MEDLINE: ] - PubMed
Thompson 1999
    1. Thompson IM, Middleton RG, Optenberg SA, Austenfeld MS, Smalley SR, Cooner WH, et al. Have complication rates decreased after treatment for localized prostate cancer? Journal of Urology 1999;162(1):107-12. [MEDLINE: ] - PubMed
Villeirs 2019
    1. Villeirs L, Tailly T, Ost P, Waterloos M, Dacaestecker K, Fonteyne V, et al. Hyperbaric oxygen therapy for radiation cystitis after pelvic radiotherapy: systematic review of the recent literature. International Journal of Urology 2019;27(2):98-107. [DOI: 10.1111/iju.14130] - DOI - PubMed
Whelan 2017
    1. Whelan HT, Kindwall EP. Hyperbaric Medical Practice. 4th edition. North Palm Beach (FL): Best Publishing Company, 2017.
Yuan 2009
    1. Yuan J, Handy RD, Moody AJ, Bryson P. Response of blood vessels in vitro to hyperbaric oxygen (HBO): modulation of VEGF and NOx release by external lactate or arginine. Biochimica et Biophysica Acta (BBA) - Bioenergetics 2009;1787(7):828-34. - PubMed
Yuan 2020
    1. Yuan J, Song L, Liu Y, Li M, Lin Q, Wang R, et al. The effects of hyperbaric oxygen therapy on pelvic radiation induced gastrointestinal complications (rectal bleeding, diarrhea, and pain): a meta-analysis. Frontiers in Oncology 2020;10:390. - PMC - PubMed

References to other published versions of this review

Bennett 2005
    1. Bennett MH, Feldmeier J, Hampson N, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No: CD005005. [DOI: 10.1002/14651858.CD005005.pub2] - DOI - PubMed
Bennett 2012
    1. Bennett MH, Feldmeier J, Hampson N, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No: CD005005. [DOI: 10.1002/14651858.CD005005.pub3] - DOI - PubMed
Bennett 2016
    1. Bennett MH, Feldmeier J, Hampson NB, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No: CD005005. [DOI: 10.1002/14651858.CD005005.pub4] - DOI - PubMed

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