Hyperbaric oxygen did not reverse the changes of radiation-induced brachial plexopathy following irradiation of early breast cancer.

Appraised by: Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital

Sydney; Tuesday, 19 September 2000

Hyperbaric oxygen did not reverse the changes of radiation-induced brachial plexopathy following irradiation of early breast cancer.

Appraised by: Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital

Sydney ; Tuesday, 19 September 2000

Clinical Scenario: A patient with pain and weakness in the arm following irradiation to the breast.

Three-part Question: For patients with brachial plexus damage following irradiation, does the administration of hyperbaric oxygen, compared to 100% oxygen at 1ATA, result in any improvement in pain or function?

Search Terms: Radiation tissue damage, breast cancer

The Study:

Double-blinded concealed randomised controlled trial with intention-to-treat.

Patients with moderate radiation- induced brachial plexopathy following irradiation for breast cancer.

Control group (N = 17; 17 analysed): 41% oxygen at 2.4ATA for 90 minutes (equivalent to 100% at 1ATA) daily for 30 treatments.

Experimental group (N = 18; 17 analysed): 100% oxygen at 2.4ATA on the same schedule as above.

The Evidence:

No clinically significant differences for McGill pain questionnaire or MOS SF-36 general health questionnaire.

Comments:

1. Cases were of relatively long-standing (median 11 yrs, range 1-29)

2. Very high compliance rate with follow-up.

3. Authors comment on two cases of marked improvement in lymphoedema

4. Some evidence of minor improvements on multiple comparisons with self-assessment questionnaires, but authors agree they are difficult to interpret.

5. A follow-up at 6 to 7 years examined McGill pain and MOS SF-16 general health questionnaires and again reported no differences between the groups.

Expiry date:  April 2003

References:

1.       Pitkin A, Pritchard J, Anand P et al. Double-blind randomised controlled trial of hyperbaric oxygen (HBO) therapy for treatment of radiation-induced brachial plexopathy (RIBP). Undersea and Hyperbaric Medicine 2000; 27(suppl):39.

2.       Pritchard J, Anand P, Broome J, Davis C, Gothard L, Hall E, Maher J, McKinna F, Millington J, Misra VP, Pitkin A, Yarnold JR. Double-blind randomized phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiother Oncol 2001 Mar;58(3):279-86.

3.       Yarnold J. Double-blind randomised phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiotherapy and Oncology2005; 77:327.