Pitkin

Hyperbaric oxygen did not reverse the changes of radiation-induced brachial plexopathy following irradiation of early breast cancer.

Clinical Bottom Line: 1. No evidence of improvement in brachial plexus function with HBOT.

Appraised by: Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital Sydney; Tuesday, 19 September 2000

Clinical Scenario: A patient with pain and weakness in the arm following irradiation to the breast.

Three-part Question: For patients with brachial plexus damage following irradiation, does the administration of hyperbaric oxygen, compared to 100% oxygen at 1ATA, result in any improvement in pain or function?

Search Terms: Radiation tissue damage, breast cancer

The Study: Double-blinded concealed randomised controlled trial with intention-to-treat. Patients with moderate radiation- induced brachial plexopathy following irradiation for breast cancer.

Control group (N = 17; 17 analysed): 41% oxygen at 2.4ATA for 90 minutes (equivalent to 100% at 1ATA) daily for 30 treatments. Experimental group (N = 18; 17 analysed): 100% oxygen at 2.4ATA on the same schedule as above.

The Evidence:

Outcome	Time to Outcome	Control group	HBO Group	Relative Risk Reduction	Absolute Risk Reduction	NNT
Warm sensory threshold normalised	12 months	0	0.18	---	0.18	6
95% CI					-0.01 to 0.36	NNT 3 to INFNNH 199 to INF

No clinically significant differences for McGill pain questionnaire or MOS SF-36 general health questionnaire.

Comments:

1. Cases were of relatively long-standing (median 11 yrs, range 1-29)

2. Very high compliance rate with follow-up.

3. Authors comment on two cases of marked improvement in lymphoedema

4. Some evidence of minor improvements on multiple comparisons with self-assessment questionnaires, but authors agree they are difficult to interpret.

5. A follow-up at 6 to 7 years examined McGill pain and MOS SF-16 general health questionnaires and again reported no differences between the groups.

Expiry date: December 2019

References:

1. Pitkin A, Pritchard J, Anand P et al. Double-blind randomised controlled trial of hyperbaric oxygen (HBO) therapy for treatment of radiation-induced brachial plexopathy (RIBP). Undersea and Hyperbaric Medicine 2000; 27(suppl):39.
2. Pritchard J, Anand P, Broome J, Davis C, Gothard L, Hall E, Maher J, McKinna F, Millington J, Misra VP, Pitkin A, Yarnold JR. Double-blind randomized phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiother Oncol 2001 Mar;58(3):279-86.
3. Yarnold J. Double-blind randomised phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiotherapy and Oncology 2005; 77:327.
4. Gothard J, Haviland J, Bryson P. Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema after radiotherapy for cancer Radiotherapy and Oncology 2010; 97:101-107

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