The concurrent administration of hyperbaric oxygen during irradiation for head and neck tumours was associated with a better five-year survival and local recurrence rate.

Clinical Bottom Line:
1. Administration of radiotherapy while in hyperbaric oxygen was associated with significantly improved 5-year survival.
2. There was a significantly lower rate of local recurrence in the hyperbaric group.
3. There was no difference in late treatment-related mortality.

Appraised by: Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Thursday, 18 February, 1999

Clinical Scenario: A patient with squamous cell carcinoma (SCC) of the tongue presented for radiotherapy. We wondered if the addition of hyperbaric oxygen would improve survival.
Three-part Question: In patients with head and neck SCC who are suitable for radiotherapy, does the addition of hyperbaric oxygen during irradiation result in improved survival?
Search Terms: Hyperbaric oxygenation, tumour/head and neck.

The Study:
Non-blinded randomised controlled trial without intention-to-treat.
Patients with SCC of the head and neck where external beam irradiation was considered the treatment of choice.
Control group (N = 15; 15 analysed): 4,500 to 5,500 rads total dose of external beam irradiation over 15 or 20 fractions according to field size.
Experimental group (N = 9; 9 analysed): 3,600 to 4,500 rads over 10 fractions while exposed to hyperbaric oxygen, (dose not specified).

The Evidence:

Outcome
Time to Outcome
Air group
HBO group
Relative risk reduction
Absolute risk reduction
NNT
Death
5 years
0.8
0.33
59%
0.47
2
95%CI:



13% to 100%
0.1 to 0.84
1 to 10
Local recurrence
5 years
0.533
0
100%
0.533
2
95% CI:




0.281 to 0.785
1 to 4
Treatment reactions
5 years
0.333
0.333
0%
0.0
0
95% CI:



-100% to 100%
-0.389 to 0.389
NNT=3 to INF NNH=3 to INF

Comments:
1. Two patients meant to receive HBO were analysed in the air group.
2. The radiation dose was different in the two arms and should be considered when interpreting this study.

Expiry date: July 2020
References:
1. Berry G, Dixon B, Ward A. The Leeds results for radiotherapy in HBO for carcinoma of the head and neck. Clinical radiology 1979; 30:591-592.
2. Berry G. A clinical appraisal of hyperbaric oxygen in head and neck cancer. Proceedings of the British Institute of Radiology 1978;51:150.




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