Radiation during hyperbaric oxygen treatment?

[Mandelin Rain]

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Man undergoing HBO for cystitis requiring transfusions related to XRT he had in distant past somewhere else. Now with rather small (T2N0)adenoca distal esophageal cancer, but not eligible for esophagectomy. Has 40 of 60 planned dives left. Bleeding from cystitis improving but still present.

What say you all?

Treat concurrent through HBO?
Stop HBO and treat?
Hold all therapy until after HBO?
Treat chemo alone and then chemorads after HBO completes?

 

[RickyScott]

Gut reaction would be to treat. Shouldn’t hyperbaric improve efficacy of radiation if anything?

 

[OTN]

I've always made sure patients were NED before starting HBO, as I was worried about increased partial pressures of O2 driving cancer cell growth. However, I just did a bit of a lit search, and it looks like my fears may have been unfounded:

Hyperbaric oxygen therapy and cancer—a review - PMC

Hypoxia is a critical hallmark of solid tumors and involves enhanced cell survival, angiogenesis, glycolytic metabolism, and metastasis. Hyperbaric oxygen (HBO) treatment has for centuries been used to improve or cure disorders involving hypoxia and ...

www.ncbi.nlm.nih.gov

 

[Mandelin Rain]

Gut reaction would be to treat. Shouldn’t hyperbaric improve efficacy of radiation if anything?

And also increase likelihood of toxicity. In a guy with history of severe late side effect, he’s a little gun shy about that possibility.

Plusjust the logistics in terms of 2 daily treatments, In different areas of town, one of which takes 2 hours.

 

[scarbrtj]

The HBO would be irrelevant to my usual thought process. The O2 is pretty gone from the system once you're outta the chamber and back to 1 ATM right?; my understanding is you're trying to have it re-vascularize avascularized/tissue-damaged spaces etc as its longer term effect.

Now what I always thought would be a super neat study would be to irradiate someone inside a dive chamber while the high amounts of O2 molecules are actually inside the body. Huge physics/engineering problem, but could be done. This might supercharge the ionizing radiation? That's the only way I think HBO and XRT could significantly interact: intra-dive XRT'ing. I have seen really big dive chambers where many people can hang out at one time, recline in recliner chairs, watch TV etc.

 

[MadamCurie]

Now what I always thought would be a super neat study would be to irradiate someone inside a dive chamber while the high amounts of O2 molecules are actually inside the body. Huge physics/engineering problem, but could be done. This might supercharge the ionizing radiation? That's the only way I think HBO and XRT could significantly interact: intra-dive XRT'ing. I have seen really big dive chambers where many people can hang out at one time, recline in recliner chairs, watch TV etc.

Hyperbaric oxygen breathing during radiotherapy has been tried in the past, and most certainly, yes, was a logistical nightmare, not to mention that you really wouldn't want a piece of electrical equipment sparking in a high O2 environment. 😱

Quite a few small(-ish) trials done in a number of sites, but the only two that showed any consistent improvement in tumor control were head & neck and cervix cancers. This wasn't necessarily surprising as those two are notorious when it comes to tumor hypoxia. (Example: Watson et al., Br J Radiol 1978 51:879-887)

 

[scarbrtj]

Hyperbaric oxygen breathing during radiotherapy has been tried in the past, and most certainly, yes, was a logistical nightmare, not to mention that you really wouldn't want a piece of electrical equipment sparking in a high O2 environment. 😱

Quite a few small(-ish) trials done in a number of sites, but the only two that showed any consistent improvement in tumor control were head & neck and cervix cancers. This wasn't necessarily surprising as those two are notorious when it comes to tumor hypoxia. (Example: Watson et al., Br J Radiol 1978 51:879-887)

While laudable I have (personally) poo-poo'ed the breathe-O2-during-XRT approach 'cause you just can in no way even get close to the amount of O2 that is driven into tissues (and thus into cells), whether or not they have access to a good blood supply, inside a dive chamber vs breathing it at 1 ATM.

One solution to the sparking problem could be cobalt source (the original solution for MR linacs as you know), or a carbon fiber dive chamber that wouldn't significantly interact with the X-ray beam (ie the linac is outside, the patient inside a carbon fiber tube pumped with high press O2).