Actinic lesions of the breasts
Frequency
5 years after radiation therapy, 23-27% of patients irradiated with breast cancer are at risk of skin lesion 2. Degree or higher. The risk of chronic pain is 8.4-11.9%. However, 90% of the patients were still satisfied with the results of the radiation therapy .
Characteristics of actinic lesions of the breasts.
Spontaneous evolution
Spontaneous development can be characterized by a slow increase in pain and loss of skin elasticity leading to hardness of the breasts. It can cause painful ulcers that do not heal.
Treatment goal
Improving the aesthetic appearance of the breast, reducing its hardness, eliminating telangiectasia, wound healing, reducing edema of the arm, if any.
Clinical studies
HBOT works with creating new vessels in the irradiated area but has no effect on telangiectasia, while the laser is very effective. On the other hand, HBOT is effective against pain and wounds which is not the case of laser. When women with after effects of radiation therapy to their breasts who received HBOT (25 sessions only) are compared to those who did not, it is found that those who received HBOT had significantly less chest pain, redness, and swelling of the chest than those who did not.
In a recent study, it appears that HBO has durably improved the quality of life, pain, the appearance of the breasts, the swelling of the arms were greatly improved.
Arm swelling is reduced with HBO. In a stunning communication over 1’000 patients suffering from radiation injury of the breast, dutch doctors found a highly significant diminution of pain, breast and arm symptoms 3 months after HBO. Quality of life was also significantly improved.
Even years after the rays, the skin regains its elasticity thanks to HBO.
Practical use of HBOT
The treatment is used as a mono therapy. As with most radiation injuries, 40 sessions are typically performed.
Actinic lesions of the colon (radiation proctitis)
Frequency
Despite modern irradiation technologies, 15% of irradiated patients with the prostate will develop a grade 2 or 3 disease of their rectum (rectitis). Recently an attempt has been made to modulate the intensity of the rays according to the patient, which has allowed only a modest decrease in the rate of radiation rectitis/ proctitis.
Characteristics of radiation proctitis
Bleeding with blood and mucus mixed with stool which can occur months or years after radiation. Diarrhea, stomach pain, bloating, incontinence. The final diagnosis and extent of inflammation is made by colonoscopy and biopsy.
Spontaneous evolution
Heavy bleeding which may require repeated blood transfusions, intestinal incontinence, pain which may require strong analgesics, alternating diarrhea and constipation.
Objectives of the treatment
Stop bleeding, healing of fistulas and infections, normalization of bowel activity, reduction of pain.
Clinical trials
2/3 of patients with severe actinic lesions of the intestine after irradiation of the prostate could be cured or improved with HBOT. In 6 of 7 patients with combined actinic lesions of the bladder and bowel, HBOT was able to significantly increase the quality of life . Similar results have been published in different types of chronic actinic lesions . Australian researchers made similar findings in the treatment of 265 consecutive patients with actinic lesions . Finally, in a high-quality study, the Americans have shown that HBOT in 120 patients suffering from actinic intestinal lesions a enabled a lasting improvement in the quality of life . The results were achieved with minimal side effects . Improvement in quality of life applies to both the bladder and the rectum in dual involvement patients. Recently, a group of specialists recommended HBOT to significantly improve quality of life in cases of radiation proctitis .
Practical use of HBOT
The treatment is used as monotherapy for patients with little discomfort. The disease generally heals and further deterioration is avoided. In the event of severe bleeding intestinal radiation, HBOT is administered in addition to hemostatic measures. HBOT can be performed on an outpatient basis. At least 40 sessions take place. Depending on the clinical presentation and the course, additional treatments may be necessary.
Actinic lesions of the bladder.
Frequency
8 à 21% of the patients who have been irradiated for a prostate cancer will develop a radiation cystitis . Radiation cystitis is often associated to a radiation proctitis.
Characteristics of radiation cystitis
Presence of blood in the urine, pain when urinating, frequent and urgent need to urinate, incontinency, social isolation. These signs can occur months or even years after the prostate has been irradiated. The final diagnosis and extent of inflammation is made by cystoscopy and bladder biopsy.
Spontaneous evolution
Increasingly frequent and heavy bleeding which may require blood transfusions, narrowing of the bladder, repeated infections, placement of an artificial bladder.
Objectives of the treatment
Stop hemorrhage, prevent fistulas and infections, improve urinary and bladder function, reduce pain.
Clinical trials
So far, there have been many good experiences with hyperbaric oxygen therapy in the treatment of severe radiation bladder. The excellent results last over 10 years. The results are better when HBOT is applied early after the first symptoms of radiation cystitis. Bleeding in biopsy proven radiation cystitis could be so nicely stopped by HBO that the relapse rate was as low as 0,12% per year. Similar results were recently found in patients with milder cases . Urge to urinate, incontinence, pain, intestinal disturbances, strength, general condition were clearly improved. All the disturbances in patients with double damage were simultaneously improved. Treatment costs are lower with HBOT than without HBOT and the quality of life is strongly improved.
HBOT also cures actinic cystitis in patients who had surgery for an enlarged prostate before their prostate cancer.
Practical use of HBOT
HBOT is administered as monotherapy in milder cases. In severe hemorrhagic cystitis, HBOT is administered in addition to hemostatic measures. HBOT can be performed on an outpatient basis. There are on average 40 sessions. Up to 60 sessions are performed in more complicated cases.
Actinic lesions of the vocal cords
Frequency
Fortunately, this is a rare complication of cancer of the neck or larynx. There are no precise data as to their frequency. Lesions generally begin between 2 months and 25 years after the rays.
Characteristics of lesions of the vocal cords.
Months or years after cancer of the vocal cords, the patient complains of hoarseness, difficulty in swallowing, pain on swallowing, false driving when swallowing food or liquid. The diagnosis is made by the ENT specialist. Without treatment, a laryngeal ulcer can occur, which requires the removal of the vocal cords (laryngectomy). With this operation, one should also expect possible surgical complications, such as fistula formation, wound healing disorders and tracheostomy.
Objective of the treatment
Avoid laryngectomy, maintain the best possible speech quality, close soft tissue fistulas. Classically, lactinic lesions are classified according to Chandler. Stage I-II can be treated conservatively Stage III-IV should undergo laryngektomy.
Clinical studies
There are no controlled studies on the treatment of radionecrosis of the vocal cords, regardless of the method of treatment. With a total of 6 smaller publications, mostly in severe cases, hyperbaric oxygen therapy ranks well. Here are the most important studies:
(1) : The larynx was saved in 6 out of 8 patients who worsened despite conventional therapy.
(2) : the larynx could be saved in 13 of the 18 patients with severe actinic lesions and was saved.
(3) : 5 out of 5 were seriously ill patients and we had similar results. Two patients who underwent a tracheostomy before the HBOT were able to close it again.
(4) : in 6 other patients with severe damage to the vocal cords (stage 4 according to Chandler), the larynx could be saved in 5 cases.
(5) : hyperbaric oxygen therapy is useful , but cannot yet be considered the gold standard.
Actinic lesions of the salivary glands
Frequency
Occurs more or less in almost all irradiated patients for cancer of the mouth and neck.
Features
Reduced salivation, which means the patient has to wet their mouth several times with water or a saliva substitute. But it can also be so strong that he can only eat liquid meals .
Diagnosis
It is usually enough for the patient to talk about a lack of saliva after oral cancer to know that he has been irradiated. The diagnosis is definitively made by the ENT or the radiotherapist.
Spontaneous evolution
The decrease or loss of saliva is permanent; it usually begins after a week of radiation.
Purpose of treatment
Saliva substitute and pilocarpine attempt to replace or stimulate saliva with modest results. Recently, attempts have been made to surgically move the salivary glands out of the radiation field before the rays . Hyperbaric oxygen therapy can promote recovery of damaged salivary glands. HBOT allows to improve the microcirculation of the salivary glands and decreases stiffness (fibrosis) of the tongue and neck in rats. Here it is again ‘an action at the genetic level .
Clinical studies
Various doctors report a good and lasting effect of hyperbaric oxygen therapy. 69 patients with xerostomia or reduced salivation were treated with HBOT. Half of patients with reduced saliva flow had improvement in saliva flow, in a quarter the improvement was still so good that the saliva was again sufficient. In a smaller study, similar results could be obtained. 13 out of 16 patients experienced measurable improvement in dry mouth . Another study examined 66 patients irradiated before and after HBOT. Questionnaires were sent before and after HBOT. Patients reported that they had less pain and less dry mouth . Another group of doctors found increased relief from dry mouth and difficulty swallowing 2 years after treatment with hyperbaric oxygen. The same group confirmed these results in a new study. Patients had significantly more saliva and a better quality of life after HBOT. In a study from Australia 64% of patients treated with HBO for radionecrosis of the jaw had an improvement in their salivation.
Practical use of the OHB
Treatment is used as additional therapy to replace saliva or pilocarpine and general dental care. There are 30 to 40 daily sessions.
Radiation damage to the jaw
Frequency
Rare, should be 1 to 2% (1) with modern radiation technology. Occurs more often in patients who continue to smoke after radiation (2).
Characteristics of radiation damage to the jaw
Non-healing mouth ulcer, pain, throat fistula, tooth loss, facial nerve damage after radiation therapy for oral cancer
Diagnosis
Examination by the maxillofacial surgeon, radiography, MRI, bone biopsy
Spontaneous evolution
Infected, non-healing wounds in the mouth and throat despite antibiotics and surgery. The bone can be so damaged that it can break just by eating.
Objectives of the treatment
Improved wound healing with the result that the operation of the jaw brings a better result, pain relief, prevention of bone fractures
Clinical trials
There are many studies out there, almost all case reports with different experiences: pro (3) , contra (4) . Only a controlled study, but with minor cases, found no argument for a positive effect of HBOT ( 5) . The situation therefore remains controversial (6) .
Practical use of OHB
Treatment is used in addition to antibiotics, pain relievers and general care and is considered a tissue improvement measure before any jaw surgery. HBOT can be performed on an outpatient basis. 30 to 60 sessions are usually necessary.
Actinic lesions of the brain
Frequency
Very rare, there are few numbers. We are talking about 4.7% of irradiated children over an average period of about 5 years and 9% of adults over a period of one year.
Features
Very variable because it depends on the location of the lesion in the brain. These range from fatigue to headaches, dizziness as well as various complaints such as paralysis, vision problems, balance problems, etc.
Spontaneous evolution
Symptoms remain stable or worsen slowly
Objective of the treatment
Improved blood circulation resulting in improved symptoms over the years. In many cases, the MRI also improves.
Clinical trials
There are no controlled studies. Success has been reported with cortisone, surgery and of course with HBOT. In a report of 10 patients with confirmed radioactive damage after brain irradiation, one was cured with HBOT and cortisone, 4 improved, 4 worsened after first improvement and died from the consequences of tumor. HBOT is worthwhile , according to the authors, because it can alleviate symptoms in patients for whom no treatment is really effective. The effect of HBOT seems clearer if the damage caused by the radiation was for benign vascular malformations or tumors or benign . Nevertheless, a book published in Amsterdam in 2011, shows a lasting improvement in brain function . In a special group of patients with actinic lesions in the visual center of the brain, improvement in vision and correlating with improved MRI images . At least 40 sessions seem necessary but results appear inconsistent. But recently it seems that treatment with the new drug bevacizumab gets better results than HBOT . More recently, patients have been treated simultaneously with HBOT and cortisone. In 10 out of 12 patients saw improvement in their neurological conditions and MRI .
Practical use of HBOT
As for other actinic lesions, at least 40 daily treatments are applied, lasting 8 weeks.