Ward
There was no benefit in terms of survival or radiation morbidity when hyperbaric oxygen was added to a radiotherapy regime for treatment of advanced carcinoma of the cervix.
Clinical Bottom Line: 1. No improvement in 5 year survival with the addition of hyperbaric oxyygen. 2. There was no reduction in the incidence of metastases or local recurrence. 3. There was a trend to increased radiotherapy-related morbidity associated with hyperbaric oxygen. Appraised by: Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital Sydney; Wednesday, 17 February, 1999
Clinical Scenario: A patient with stage III carcinoma of the cervix presented for radiotherapy. Three-part Question: In treating advanced cervical carcinoma with radiotherapy, does the addition of hyperbaric oxygenation during irradiation result in any improvement in survival? Search Terms: Hyperbaric oxygenation, carcinoma of the cervix
The Study: Non-blinded randomised controlled trial without intention-to-treat. Patients with advanced carcinoma of the cervix (Stages IIb and III), in whom radiotherapy was considered the treatment of choice. Control group (N = 48; 47 analysed): Three 'Cathetron' implants for radiotherapy at two weekly intervals with 10 external fractions bracketed around the second insertion to a total dose of 6,000rads. Experimental group (N = 39; 36 analysed): As above, but external beam irradiation given while receiving hyperbaric oxygenation (dose not stated).
The Evidence:
| Outcome | Time to Outcome | Air group | HBO group | Relative risk increase | Absolute risk increase | NNH |
| Radiation morbidity | 2 years | 0.13 | 0.22 | 69% | 0.09 | 11 |
| 95% CI: | 55% to 100% | -0.07 to 0.25 | NNT14 to INF NNH4 to INF | |||
| death | 5 years | .54 | .62 | 15% | 0.08 | 12 |
| 95% CI: | 24% to 53% | -0.13 to 0.29 | NNT3 to INF NNH8 to INF |
Comments: 1. 5 patients were analysed in the air group when randomised to receive hyperbaric oxygen. 2. Patients not completing therapy were excluded from analysis. 3. Survival figures were not given in the text, but read off the figure. 4. This study follows on from Watson et al with a change in radiotherapy regime.
Expiry date:January 2004 References: 1. Ward AJ, Dixon B. Carcinoma of the cervix: results of a hyperbaric oxygen trial associated with the use of the Cathetron. Clinical Radiology 1979; 30:383-387. 2. Ward AJ, Dixon B, Stubbs B. A clinical appraisal of hyperbaric oxygen in cervix cancer. Proceedings of The British Institute of Radiotherapy 1978;51:150-151.
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