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Oncol Lett. 2018 Nov;16(5):5813-5822. doi: 10.3892/ol.2018.9397. Epub 2018 Sep 5.

Intra-tumoral treatment with oxygen-ozone in glioblastoma: A systematic literature search and results of a case series.

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Department of Neurosurgery, Klinikum St. Marien, D-92224 Amberg, Germany.
Department of Neuropathology, Regensburg University Hospital, D-93053 Regensburg, Germany.
Medical Sociology, Institute of Epidemiology and Preventative Medicine, University of Regensburg, D-93053 Regensburg, Germany.
Department of Radiology, Klinikum St. Marien, D-92224 Amberg, Germany.
Department of Neurosurgery, University of Erlangen-Nürnberg, D-91054 Erlangen, Germany.


Despite progress in surgery and radiochemotherapy, the prognosis of glioblastoma (GB) remains poor. GB cells exhibit a preference for hypoxia to maintain their tumor-forming capacity. Treatment strategies utilizing oxygen (O2) or ozone (O3) and generating reactive oxygen species induce cell growth inhibition and apoptosis. The anti-tumorigenic properties of O2-O3 are accompanied by a key role in regulating immunogenicity. The present study reported a case series of an intra-tumoral O2-O3 application in recurrent GB. Following surgery in combination with standard radiochemotherapy, O2-O3 (5 ml at 40 µg/ml) was applied every four weeks into the tumor vicinity. The patients received a median of 27 (range, 3-44) O2-O3 applications. In addition, a systematic literature search was performed in order to evaluate the role of O3 in the treatment of malignancies. The median overall survival rate was 40 (range, 16-53) months. The median survival rate following the first recurrence or the initiation of the O2-O3 treatment, respectively, was 34 (range, 12-53) months. In one patient, a local infection and in another, hemorrhage occurred, necessitating in both the temporary removal of the reservoir. The data from the present study support the potential benefit of an intra-tumoral O2-O3 application in recurrent GB. The scientific literature revealed by the bibliographic search suggests that O3 may be considered a viable adjuvant therapy in oncological patients. The present study may serve as a starting point for further observational and clinical studies elucidating the cellular and systemic effects of O2 and/or O3 and demonstrating their efficacy and safety in larger patient samples.


glioblastoma; intra-tumoral treatment; oxygen; ozone

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