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Can J Neurol Sci. 2019 Aug 30:1-8. doi: 10.1017/cjn.2019.290. [Epub ahead of print]

Hyperbaric Oxygen for Radiation Necrosis of the Brain.

Author information

1
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
2
Hyperbaric Medicine Unit, Toronto General Hospital, University Health Network, Toronto, Canada.
3
Federal University of Rio Grande do Norte, Natal/RN, Brazil.
4
Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Canada.

Abstract

in English, French

INTRODUCTION:

Hyperbaric oxygen therapy (HBOT) shows promising results in treating radionecrosis (RN) but there is limited evidence for its use in brain RN. The purpose of this study is to report the outcomes of using HBOT for symptomatic brain RN at a single institution.

METHODS:

This was a retrospective review of patients with symptomatic brain RN between 2008 and 2018 and was treated with HBOT. Demographic data, steroid use, clinical response, radiologic response and toxicities were collected. The index time for analysis was the first day of HBOT. The primary endpoint was clinical improvement of a presenting symptom, including steroid dose reduction.

RESULTS:

Thirteen patients who received HBOT for symptomatic RN were included. The median time from last brain radiation therapy to presenting symptoms of brain RN was 6 months. Twelve patients (92%) had clinical improvement with median time to symptom improvement of 33 days (range 1-109 days). One patient had transient improvement after HBOT but had recurrent symptomatic RN at 12 months. Of the eight patients with evaluable follow-up MRI, four patients had radiological improvement while four had stable necrosis appearance. Two patients had subsequent deterioration in MRI appearances, one each in the background of initial radiologic improvement and stability. Median survival was 15 months with median follow-up of 10 months. Seven patients reported side effects attributable to HBOT (54%), four of which were otologic in origin.

CONCLUSIONS:

HBOT is a safe and effective treatment for brain RN. HBOT showed clinical and radiologic improvement or stability in most patients. Prospective studies to further evaluate the effectiveness and side effects of HBOT are needed.

KEYWORDS:

Abnormalities; Brain neoplasms; Hyperbaric oxygenation; Necrosis; Radiation-induced

PMID:
31466539
DOI:
10.1017/cjn.2019.290

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