Xin
The adjunctive use of hyperbaric oxygen with chemotherapy for malignant lymphoma significantly reduced tumour size and may confer longer remission and improved survival.
Clinical Bottom Line: 1. Hyperbaric oxygen significantly reduced tumour size and improved the rate of induction of complete remission in patients receiving a chemotherapy regime. 2. There appeared to be some advantage in survival and the period of complete remission obtained if hyperbaric oxygen is used. Appraised by: Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Saturday, 24 July 1999
Clinical Scenario: A patient with malignant lymphoma presented for chemotherapy. We wondered if the administration of hyperbaric oxygen would improve outcome. Three-part Question: For patients having chemotherapy for the treatment of malignant lymphoma, does the concomitant administration of hyperbaric oxygen result in any benefit in tumour control? Search Terms: Hyperbaric oxygenation, malignant lymphoma
The Study: Non-blinded pseudo-randomised controlled trial with intention-to-treat. Patients with clincal and pathological diagnosis of malignant lymphoma who were scheduled for chemotherapy. Control group (N = 21; ?21 analysed): A combination chemotherapy regime using adriamycin, bleomycin, cyclophosphamide, vincristine and dexamethasone over 14 days. Experimental group (N = 20; ?20 analysed): As above with the addition of 100%oxygen at 2.5 ATA for 2 hours daily for 14 days at the time of peak drug blood concentration of chemotherapeutic agents.
The Evidence:
| Outcome | Time to Outcome | Chemo group | HBO group | Relative Risk Reduction | Absolute Risk Reduction | NNT |
| Patients with complete remission | unknown | 0.48 | 0.85 | -79% | -0.374 | -3 |
| 95% CI: | -100% to -23% | -0.639 to -0.109 | -9 to -2 |
Non-Event Outcomes Time to outcome Chemo group HBO group P-value Tumour area reduction (sq cm) 14 days 8.8 15.5 <0.01
Duration of complete remission (months) unknown 8.2 15.7 <0.01
Average survival (months) unknown 11.4 18.9 <0.01
Comments: 1. Pseudo-randomised, non-blinded study and therefore some increased chance of bias. 2. It is not clear how many patients reached final follow-up form the data presented. 3. Survival and remission times are not clearly presented, making interpretation difficult. 4. Laboratory data is presented but not discussed, although there were a number of significant differences reported. 5. No complications reported of combined administration of bleomycin and oxygen.
Expiry date:April 2003 References: 1. Xin PJ, Miao GC, Zong WC, Rong WS, Min LJ, Yingying C, An ZS, Song LT. The influence of hyperbaric oxygenation on chemotherapy effects in patients with malignant lymphoma. In: Wen-ren Li, Proceedings of the Eleventh International Congress on Hyperbaric Medicine, Fuzhou. Best Publishing, Flagstaff, Arizona 1993:44-47. 2. Xin PJ, Miao GC, Zong WC, Rong WS, Min LJ, Yingying C, An ZS, Song LT. The influence of hyperbaric oxygenation on chemotherapy effects in patients with malignant lymphoma. In: Wen-ren Li, Proceedings of the Eleventh International Congress on Hyperbaric Medicine, Fuzhou. Best Publishing, Flagstaff, Arizona 1993:16-17.
