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'''Administration of hyperbaric oxygen during radiotherapy for carcinoma of the uterine cervix did not improve survival rate at a minimum of 2 years.''' 

'''Clinical Bottom Line:''' 
1. There was no evidence of an improvement in survival rate with the simultaneous administration of hyperbaric oxygen during radiotherapy for carcinoma of the uterine cervix. 
2. There was no evidence of increased complications in the hyperbaric oxygen group. 
'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Oxygen, Prince of Wales Hospital, Sydney; Monday, 22 March 1999 

'''Clinical Scenario:''' A patient with advanced carcinoma of the uterine cervix presented for radiotherapy. We wondered if the administration of hyperbaric oxygen at the time of radiotherapy would improve survival or local recurrence rates. 
'''Three-part Question:''' In patients with advanced carcinoma of the uterine cervix where radiotherapy is the treatment of choice, does the simultaneous administration of hyperbaric oxygen as compared to radiotherapy in air, result in any improvement in survival or local recurrence rate? 
'''Search Terms:''' Cervix, neoplasms 

'''The Study:''' 
Non-blinded concealed randomised controlled trial without intention-to-treat. 
Patients with Stage IIB to IVA cancer of the uterine cervix, aged under 70 years. They underwent a complex staging protocol and were stratified for stage prior to randomisation. 
Control group (N = 124; 124 analysed): Radiotherapy fields and dose were varied by extent of involvement and given in a standard 5 fractions/week schedule over 4 to 5 weeks. More advanced cases received implanted radium in addition. No sham treatment. 
Experimental group (N = 109; 109 analysed): Radiotherapy schedule as above, but undertaken while breathing 100% oxygen at 3ATA, exact profile not given but 20 minute soak period prior to radiotherapy. 

'''The Evidence:''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Air group''' || '''HBO group''' || '''Relative benefit increase''' || '''Absolute benefit increase''' || '''NNT''' 
|-
| '''Survival with no evidence of disease''' || Min 2 years || 0.411 || 0.330 || 20% || 0.081 || 12 
|-
| '''95% CI:''' || || || || -10% to 50% || -0.043 to 0.205 || NNT'''5 to INF NNH'''23 to INF 
|-
|}

'''Comments:''' 
1. Failure rate of local control was reported as unaffected by hyperbaric oxygen, although figures not given. 
2. This trial studied the effect of hyperbaric oxygen in a conventional dosing schedule. 

'''Expiry date:'''January 2004 
'''References:''' 1. Fletcher GH, Lindberg RD, Caderao JB, Wharton JT. Hyperbaric oxygen as a radiotherapeutic adjuvant in advanced cancer of the uterine cervix. Preliminary results of a randomised trial. Cancer 1977; 39:617-623. 
2. Lindberg RD, Fletcher GH, Caderao JB. Present status of high-pressure oxygen in radiotherapy. Proceedings of the XIII International Congress of Radiology. Amsterdam Excerpta Medica 1973; 1:665-670. 
3. Fletcher GH, Lindberg RD, Caderao JB, Wharton JT. The preliminary results of a randomised trial of patients with late stage cancer of the uterine cervix using hyperbaric tank or atmospheric oxygen. Proceedings of the American Radium Society 1975;341-346.


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