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: January 2004
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.
