Gordoben: Imported from Wikispaces

2011-12-31T02:34:00Z

Imported from Wikispaces

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'''The conduct of radiotherapy in an environment of hyperbaric oxygenation improved survival in carcinoma of the urinary bladder.''' 

'''Clinical Bottom Line:''' 
1. The addition of hyperbaric oxygenation to a regime of radiotherapy for cancer of the bladder resulted in a significant reduction in mortality over two years. 
2. Mortality was high in both groups. 

'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital 
Sydney; Friday, 11 December, 1998 

'''Clinical Scenario:''' A patient with bladder cancer where radiotherapy is the treatment of choice. 
'''Three-part Question:''' In urinary bladder carcinoma being treated with radiotherapy, does exposure to the radiation dose while having hyperbaric oxygen, compared to normal air breathing, result in any improvement in recurrence rate, mortality or morbidity? 
'''Search Terms:''' Hyperbaric oxygenation, radiotherapy, tumours/bladder. 

'''The Study:''' 
Non-blinded randomised controlled trial with intention-to-treat. 
Patients with staged bladder cancer presenting for radiotherapy. 
Control group (N = 21; 21 analysed): 6,000 rads over six weeks, giving four or five fractions each week. No attempt to sham treatment. 
Experimental group (N = 19; 19 analysed): 4,800 rads over 29-32 days in 12 fractions while breathing 100% oxygen at 3ATA for about 40 minutes. 

'''The Evidence:''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Air Group''' || '''HBO Group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT''' 
|-
| '''Survival''' || 6 months || 0.810 || 0.895 || 10% || 0.09 || 12 
|-
| '''95% CI:''' || || || || -16% to 37% || -0.13 to 0.30 || NNT'''3 to INF NNH'''8 to INF 
|-
| '''Survival''' || 48 months || 0.048 || 0.105 || 119% || 0.06 || 18 
|-
| '''95% CI:''' || || || || 100% to -100% || -0.11 to 0.22 || NNT'''4 to INF NNH'''9 to INF 
|-
|}

'''Non-Event O''''''utcomes'''

'''Outcome Time to outcome P-value''' 

Survival 
analysis 0-27 months P<0.05

'''Comments:''' 
1. Small study did not show significant differences at point estimates of survival. 
2. Radiotherapy regime was different between the two groups. 
3. The significance for present treatment of bladder cancer is not clear. 

'''Expiry date:''' January 2004 
'''References:''' 1. Plenk HP. Hyperbaric radiation therapy. Preliminary results of a randomised study of cancer of the urinary bladder and review of the 'oxygen experience'. Am J Roentgenol Radium Ther Nucl Med. 1972; 114:152-157. 


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

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Gordoben: Imported from Wikispaces