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'''There was no improvement in survival over one year with the addition of hyperbaric oxygen to the radiotherapy regime for carcinoma of the bronchus or urinary bladder. '''
{|
| '''Clinical Bottom Line: '''
|-
| 1. No evidence of improved survival with the addition of hyperbaric oxygen to the radiotherapy regime for carcinoma of the bronchus or urinary bladder.
|-
|}
'''Appraised by:''' Mike Bennett, Dept. of Diving and Hyperbaric Oxygen, Prince of Wales Hospital, Sydney; Friday, 19 March 1999 

'''Clinical Scenario:''' A patient with carcinoma of the bronchus presented for radiotherapy. We wondered if there was any efficacy in giving hyperbaric oxygen in combination. 
'''Three-part Question:''' In patients with carcinoma of the bronchus or bladder, does the administration of hyperbaric oxygen during radiotherapy, compared to radiotherapy in air, result in any improvement in survival? 
'''Search Terms:''' Neoplasms bronchus/bladder, radiotherapy 

'''The Study:''' 
Non-blinded concealed randomised controlled trial with intention-to-treat. 
Two groups. 1. Patients under 75 years with carcinoma of the bronchus <150cm2 in size, no previous radiotherapy. 2. Patients under 75 years with carcinoma of the urinary bladder with tumour and nodes confined to the pelvis. 
Control group 1.(N = 24; 24 analysed) 2.(N = 20; 20 analysed): Radiotherapy to a total tumour dose of 6,000R over 8 weeks using daily fractions 5 days per week. 
Experimental group (N = 25; 25 analysed) 2. (n = 20; 20 analysed): Identical radiotherapy regime while at 3ATA breathing 100% oxygen. Total chamber time 40mins. 

'''The Evidence:''' 

'''Bronchus''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Air group''' || '''HBO group''' || '''Relative survival reduction''' || '''Absolute survival reduction''' || '''NNH''' 
|-
| '''Survival''' || 13 months || 0.25 || 0.2 || 20% || 0.050 || 20 
|-
| '''95%CI :''' || || || || -73% to 100% || -0.184 to 0.284 || NNH'''4 to INF NNT=5 to INF 
|-
|}

'''Bladder''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Air group''' || '''HBO group''' || '''Relative survival reduction''' || '''Absolute survival reduction''' || '''NNH''' 
|-
| '''Survival''' || 13 months || 0.4 || 0.300 || 25% || 1.009 || 10 
|-
| '''95%CI :''' || || || || -49% to 98% || -0.194 to 0.394 || NNH'''3 to INF NNT=5 to INF 
|-
|}

'''Comments:''' 
1. Two small trials with low power. 
2. Some increase in the numbers of subjects with metastases from bladder carcinoma in the oxygen group. 
3. It is not clear if these patients are also reported in Cade 78 and Kirk 76. 
3. Relevance to practice today is low. 

'''Expiry date:'''January 2004
'''References:''' 
1. Cade IS, McEwen JB. Megavoltage radiotherapy in hyperbaric oxygen. A controlled trial. Cancer 1967; 20:817-821. 
2. McEwen JB. Clinical trials of hyperbaric oxygen and radiotherapy. Proceedings of the British Institute of Radiology. British Journal of Radiology 1968; 41:556. 


[[File:http://www.hboevidence.com/_themes/copy-of-sumi-painting/sumhorsa.gif]]

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