The adjunctive use of hyperbaric oxygen with chemotherapy for malignant lymphoma significantly reduced tumour size and may confer longer remission and improved survival.

Clinical Bottom Line:

1. Hyperbaric oxygen significantly reduced tumour size and improved the rate of induction of complete remission in patients receiving a chemotherapy regime.

2. There appeared to be some advantage in survival and the period of complete remission obtained if hyperbaric oxygen is used.

Appraised by: Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Saturday, 24 July 1999

Clinical Scenario: A patient with malignant lymphoma presented for chemotherapy. We wondered if the administration of hyperbaric oxygen would improve outcome.

Three-part Question: For patients having chemotherapy for the treatment of malignant lymphoma, does the concomitant administration of hyperbaric oxygen result in any benefit in tumour control?

Search Terms: Hyperbaric oxygenation, malignant lymphoma

The Study:

Non-blinded pseudo-randomised controlled trial with intention-to-treat.

Patients with clincal and pathological diagnosis of malignant lymphoma who were scheduled for chemotherapy.

Control group (N = 21; ?21 analysed): A combination chemotherapy regime using adriamycin, bleomycin, cyclophosphamide, vincristine and dexamethasone over 14 days.

Experimental group (N = 20; ?20 analysed): As above with the addition of 100%oxygen at 2.5 ATA for 2 hours daily for 14 days at the time of peak drug blood concentration of chemotherapeutic agents.

The Evidence:

Non-Event Outcomes    Time to outcome   Chemo group   HBO group   P-value

Tumour area

reduction (sq cm)         14 days            8.8        15.5       <0.01

Duration of complete

remission (months)        unknown            8.2        15.7       <0.01

Average survival

(months)                  unknown            11.4       18.9       <0.01

Comments:

1. Pseudo-randomised, non-blinded study and therefore some increased chance of bias.

2. It is not clear how many patients reached final follow-up form the data presented.

3. Survival and remission times are not clearly presented, making interpretation difficult.

4. Laboratory data is presented but not discussed, although there were a number of significant differences reported.

5. No complications reported of combined administration of bleomycin and oxygen.

Expiry date:  April 2003

References: 1. Xin PJ, Miao GC, Zong WC, Rong WS, Min LJ, Yingying C, An ZS, Song LT. The influence of hyperbaric oxygenation on chemotherapy effects in patients with malignant lymphoma. In: Wen-ren Li, Proceedings of the Eleventh International Congress on Hyperbaric Medicine, Fuzhou. Best Publishing, Flagstaff, Arizona 1993:44-47.

2. Xin PJ, Miao GC, Zong WC, Rong WS, Min LJ, Yingying C, An ZS, Song LT. The influence of hyperbaric oxygenation on chemotherapy effects in patients with malignant lymphoma. In: Wen-ren Li, Proceedings of the Eleventh International Congress on Hyperbaric Medicine, Fuzhou. Best Publishing, Flagstaff, Arizona 1993:16-17.