logo hyperbaric center Basel HYPERBARIC CENTER BASEL german flag french flag

Home    Diving Medicine    Hyperbaric Medicine

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.

Dilation of the small skin vessels in the form of telangiectasia, pain, hardness of the breasts in certain cases and ultimate chronic skin ulceration, chronic swelling of the arm on the irradiated side.

Spontaneous evolution

Spontaneous development can be characterized by a slow increase in pain and chest hardness. 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 . 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 doctors and patients say that HBOT improves over the long term shoulder mobility, reduces edema and fibrosis of the breast.

Practical use of HBOT

The treatment is used as a monotherapy. 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 rectitis or proctitis. 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 recttitis/ 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.

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.