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2018-03-16T03:30:53Z

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'''The addition of hyperbaric oxygen to radiotherapy for the treatment of maxillary antrum carcinoma was not associated with improved local tumour control or survival.''' 

{|
| '''Clinical Bottom Line: '''
|-
| 1. There was no improvement in survival with maxillary antrum carcinoma by the addition of hyperbaric oxygen therapy. 2. There was no evidence of a significant reduction in local tumour recurrence with hyperbaric oxygen.
|-
|}
'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital 
Sydney; Saturday, 27 March 1999 

'''Clinical Scenario:''' A patient presented with squamous cell carcinoma of the maxillary antrum for radiotherapy. 
'''Three-part Question:''' For patients with carcinoma of the maxillary antrum, does the addition of hyperbaric oxygen to a course of radiotherapy result in an improvement in local control or survival? 
'''Search Terms:''' Radiotherapy, carcinoma/head and neck. 

'''The Study:''' 
Non-blinded pseudo-randomised controlled trial with intention-to-treat. 
Patients under 70 years with maxillary antrum carcinoma without evidence of metastases or nodal disease. 
Control group (N = 21; 21 analysed): 8 to 10 fractions of radiotherapy on a twice weekly schedule to a total dose of 6,000 to 7,000 R, modified by judgement of treating staff. 
Experimental group (N = 21; 21 analysed): 8 to 10 fractions of radiotherapy on the same schedule to a total dose of 4,000 to 5,000 R, modified by judgement of the staff. 

'''The Evidence:''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Air group''' || '''HBO group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT''' 
|-
| '''Survival''' || 1 year || 0.476 || 0.476 || 0% || 0.0 || 0 
|-
| '''95% CI:''' || || || || -63% to 63% || -0.30 to 0.30 || NNT'''3 to INF NNH'''3 to INF 
|-
| '''Recurrence''' || 1 year || 0.76 || 0.67 || 12% || 0.09 || 11 
|-
| '''95% CI:''' || || || || -24% to 48% || -0.18 to 0.36 || NNT'''3 to INF NNH'''6 to INF 
|-
| '''Primary not cleared''' || 3 months || 0.29 || 0.24 || 17% || 0.05 || 21 
|-
| '''95% CI:''' || || || || -70% to 100% || -0.22 to 0.32 || NNT'''3 to INF NNH'''5 to INF 
|-
|}

'''Comments:''' 
1. The report indicates considerable variation in treatment regimen, but does not report actual treatments given. 
2. Pseudo-randomisation by admission order may be problematic. 
3. Comparisons made with different groups from outside the study are confusing. 

'''Expiry date:''' July 2020
'''References:''' 
1. Shigematsu Y, Fuchihata H, Makino T, Inoue T. Radiotherapy with reduced fraction in head and neck cancer, with special reference to hyperbaric oxygen radiotherapy in maxillary sinus carcinoma (a controlled study). In: Radiobiology and Radiotherapy, Sugahara T, Rivesz I, Scott O eds, Tokyo 1973:180-187. 


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Gordoben: Imported from Wikispaces