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 INF NNH 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:
- 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.
- 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.
- Yarnold J. Double-blind randomised phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiotherapy and Oncology 2005; 77:327.
- 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
