Xin
The adjunctive use of hyperbaric oxygen with chemotherapy for malignant lymphoma significantly reduced tumour size and may confer longer remission and improved survival.
Clinical Bottom Line:
1. Hyperbaric oxygen significantly reduced tumour size and improved the rate of induction of complete remission in patients receiving a chemotherapy regime.
2. There appeared to be some advantage in survival and the period of complete remission obtained if hyperbaric oxygen is used.
Appraised by: Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Saturday, 24 July 1999
Clinical Scenario: A patient with malignant lymphoma presented for chemotherapy. We wondered if the administration of hyperbaric oxygen would improve outcome.
Three-part Question: For patients having chemotherapy for the treatment of malignant lymphoma, does the concomitant administration of hyperbaric oxygen result in any benefit in tumour control?
Search Terms: Hyperbaric oxygenation, malignant lymphoma
The Study: Non-blinded pseudo-randomised controlled trial with intention-to-treat. Patients with clincal and pathological diagnosis of malignant lymphoma who were scheduled for chemotherapy.
Control group (N = 21; ?21 analysed): A combination chemotherapy regime using adriamycin, bleomycin, cyclophosphamide, vincristine and dexamethasone over 14 days.
Experimental group (N = 20; ?20 analysed): As above with the addition of 100%oxygen at 2.5 ATA for 2 hours daily for 14 days at the time of peak drug blood concentration of chemotherapeutic agents.
The Evidence:
Outcome |
Time to Outcome |
Chemo group |
HBO group |
Relative Risk Reduction |
Absolute Risk Reduction |
NNT |
|
Patients with complete remission |
unknown |
0.48 |
0.85 |
-79% |
-0.374 |
-3 |
95% CI: |
-100% to -23% |
-0.639 to -0.109 |
-9 to -2 | |||
Non-Event Outcomes |
Time to outcome |
Chemo group |
HBO group |
P-value |
|
Tumour area reduction (sq cm) |
14 days |
8.8 |
15.5 |
<0.01 |
|
Duration of complete remission (months) |
unknown |
8.2 |
15.7 |
<0.01 |
|
Average survival (months) |
unknown |
11.4 |
18.9 |
<0.01 |
Comments:
1. Pseudo-randomised, non-blinded study and therefore some increased chance of bias.
2. It is not clear how many patients reached final follow-up form the data presented.
3. Survival and remission times are not clearly presented, making interpretation difficult.
4. Laboratory data is presented but not discussed, although there were a number of significant differences reported.
5. No complications reported of combined administration of bleomycin and oxygen.
Expiry date: April 2023
References: 1. Xin PJ, Miao GC, Zong WC, Rong WS, Min LJ, Yingying C, An ZS, Song LT. The influence of hyperbaric oxygenation on chemotherapy effects in patients with malignant lymphoma. In: Wen-ren Li, Proceedings of the Eleventh International Congress on Hyperbaric Medicine, Fuzhou. Best Publishing, Flagstaff, Arizona 1993:44-47.
2. Xin PJ, Miao GC, Zong WC, Rong WS, Min LJ, Yingying C, An ZS, Song LT. The influence of hyperbaric oxygenation on chemotherapy effects in patients with malignant lymphoma. In: Wen-ren Li, Proceedings of the Eleventh International Congress on Hyperbaric Medicine, Fuzhou. Best Publishing, Flagstaff, Arizona 1993:16-17.
