Difference between revisions of "Xin"
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− | <span style="font- | + | <span style="font-size:x-large;"><span style="font-family: Arial, Helvetica, sans-serif;">'''The adjunctive use of hyperbaric oxygen with chemotherapy for malignant lymphoma significantly reduced tumour size and may confer longer remission and improved survival.'''</span></span> |
− | <span style="font-family: Arial,Helvetica,sans-serif | ||
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− | <span style=" | + | <span style="font-size:large;"><span style="font-family: Arial, Helvetica, sans-serif;">'''Clinical Bottom Line:'''</span></span> |
− | <span style="font-family: Arial,Helvetica,sans-serif | ||
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− | <span style=" | + | <span style="font-size:large;"><span style="font-family: Arial, Helvetica, sans-serif;">1. Hyperbaric oxygen significantly reduced tumour size and improved the rate of induction of complete remission in patients receiving a chemotherapy regime.</span></span> |
− | <span style="font-family: Arial,Helvetica,sans-serif | ||
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− | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;"> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;"><span style="font-size:large;">2. There appeared to be some advantage in survival and the period of complete remission obtained if hyperbaric oxygen is used.</span></span> |
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+ | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by:''' Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Saturday, 24 July 1999</span> | ||
+ | |||
+ | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Scenario:''' A patient with malignant lymphoma presented for chemotherapy. We wondered if the administration of hyperbaric oxygen would improve outcome.</span> | ||
+ | |||
+ | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''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?</span> | ||
+ | |||
+ | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Search Terms:''' Hyperbaric oxygenation, malignant lymphoma</span> | ||
+ | |||
+ | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:''' </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Non-blinded pseudo-randomised controlled trial with intention-to-treat. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Patients with clincal and pathological diagnosis of malignant lymphoma who were scheduled for chemotherapy.</span> | ||
+ | |||
+ | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Control group (N = 21; ?21 analysed): A combination chemotherapy regime using adriamycin, bleomycin, cyclophosphamide, vincristine and dexamethasone over 14 days.</span> | ||
+ | |||
+ | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">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.</span> | ||
+ | |||
+ | | ||
+ | |||
+ | <span style="font-size:medium;"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"="">The Evidence:</span>'''</span></span> | ||
+ | |||
+ | {| class="Table" style="border:solid windowtext 1.0pt" | ||
+ | |- | ||
+ | | style="border: 1pt solid windowtext; width: 142px;" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Outcome</span></span>'''</span></p> | ||
+ | | style="border: 1pt solid windowtext; width: 96px;" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Time to Outcome</span></span>'''</span></p> | ||
+ | | style="border: 1pt solid windowtext; width: 81px;" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Chemo group</span></span>'''</span></p> | ||
+ | | style="border: 1pt solid windowtext; width: 74px;" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">HBO group</span></span>'''</span></p> | ||
+ | | style="border: 1pt solid windowtext; width: 126px;" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Relative Risk Reduction</span></span>'''</span></p> | ||
+ | | style="width: 137px; border: 1pt solid windowtext;" width="100" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Absolute Risk Reduction</span></span>'''</span></p> | ||
+ | | style="width: 184px; border: 1pt solid windowtext;" width="50" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNT</span></span>'''</span></p> | ||
+ | |- | ||
+ | | rowspan="2" style="border: 1pt solid windowtext; width: 142px;" | | ||
+ | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Patients with complete remission</span></span>'''</span> | ||
+ | |||
+ | | style="border: 1pt solid windowtext; width: 96px;" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">unknown</span></span></span></p> | ||
+ | | style="border: 1pt solid windowtext; width: 81px;" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.48</span></span></span></p> | ||
+ | | style="border: 1pt solid windowtext; width: 74px;" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.85</span></span></span></p> | ||
+ | | style="border: 1pt solid windowtext; width: 126px;" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-79%</span></span></span></p> | ||
+ | | style="width: 137px; border: 1pt solid windowtext;" width="100" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-0.374</span></span></span></p> | ||
+ | | style="width: 184px; border: 1pt solid windowtext;" width="50" | <p style="padding: 0.75pt; text-align: center;"><span style="font-size:small;"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"="">-3</span></span></span></p> | ||
+ | |- | ||
+ | | colspan="3" style="border: 1pt solid windowtext; width: 265px;" | <p align="right" style="margin-bottom:0cm; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI:</span></span></span></p> | ||
+ | | style="border: 1pt solid windowtext; width: 126px;" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-100% to -23%</span></span></span></p> | ||
+ | | style="width: 137px; border: 1pt solid windowtext;" width="100" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">-0.639 to -0.109</span></span></span></p> | ||
+ | | style="width: 184px; border: 1pt solid windowtext;" width="50" | <p style="padding: 0.75pt; text-align: center;"><span style="font-size:small;"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"="">-9 to -2</span></span></span></p> | ||
+ | |} | ||
+ | |||
+ | | ||
+ | |||
+ | {| class="MsoTableGrid" style="border-collapse:collapse; border:solid windowtext 1.0pt" | ||
+ | |- | ||
+ | | style="width:205.3pt; border:solid windowtext 1.0pt" width="274" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Non-Event Outcomes</span></span>'''</span></p> | ||
+ | | style="width:70.9pt; border:solid windowtext 1.0pt; border-left:none" width="95" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Time to outcome</span></span>'''</span></p> | ||
+ | | style="width:63.75pt; border:solid windowtext 1.0pt; border-left:none" width="85" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Chemo group</span></span>'''</span></p> | ||
+ | | style="width:2.0cm; border:solid windowtext 1.0pt; border-left:none" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">HBO group</span></span>'''</span></p> | ||
+ | | style="width:54.15pt; border:solid windowtext 1.0pt; border-left:none" width="72" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">P-value</span></span>'''</span></p> | ||
|- | |- | ||
− | | <span style'''"font-family: | + | | style="width:205.3pt; border:solid windowtext 1.0pt; border-top:none" width="274" | |
+ | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Tumour area reduction (sq cm)</span></span>'''</span> | ||
+ | |||
+ | | style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="95" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">14 days</span></span></span></p> | ||
+ | | style="width:63.75pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">8.8</span></span></span></p> | ||
+ | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">15.5</span></span></span></p> | ||
+ | | style="width:54.15pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="72" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><0.01</span></span></span></p> | ||
|- | |- | ||
− | | <span style'''"font-family: | + | | style="width:205.3pt; border:solid windowtext 1.0pt; border-top:none" width="274" | |
+ | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Duration of complete remission (months)</span></span>'''</span> | ||
+ | |||
+ | | style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="95" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">unknown</span></span></span></p> | ||
+ | | style="width:63.75pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">8.2</span></span></span></p> | ||
+ | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">15.7</span></span></span></p> | ||
+ | | style="width:54.15pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="72" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><0.01</span></span></span></p> | ||
|- | |- | ||
+ | | style="width:205.3pt; border:solid windowtext 1.0pt; border-top:none" width="274" | | ||
+ | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Average survival (months)</span></span>'''</span> | ||
+ | |||
+ | | style="width:70.9pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="95" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">unknown</span></span></span></p> | ||
+ | | style="width:63.75pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">11.4</span></span></span></p> | ||
+ | | style="width:2.0cm; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">18.9</span></span></span></p> | ||
+ | | style="width:54.15pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt" width="72" | <p align="center" style="text-align:center; padding:0cm 5.4pt 0cm 5.4pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><0.01</span></span></span></p> | ||
|} | |} | ||
− | <span style="font-family: Arial,Helvetica,sans-serif; font-size: | + | |
− | + | ||
− | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Comments:'''</span> | |
− | <span style="font-family: Arial,Helvetica,sans-serif; font-size: | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Pseudo-randomised, non-blinded study and therefore some increased chance of bias.</span> |
− | |||
− | <span style="font-family: Arial,Helvetica,sans-serif; font-size: | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. It is not clear how many patients reached final follow-up form the data presented.</span> |
− | |||
− | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. Survival and remission times are not clearly presented, making interpretation difficult.</span> | |
− | |||
− | |||
− | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. Survival and remission times are not clearly presented, making interpretation difficult | ||
− | |||
− | |||
− | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;"> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">4. Laboratory data is presented but not discussed, although there were a number of significant differences reported.</span> |
− | |||
− | |||
+ | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">5. No complications reported of combined administration of bleomycin and oxygen.</span> | ||
− | </span> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Expiry date: '''April 2023</span> |
− | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''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.</span> | |
− | <span style="color: #7c00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 26px; text-align: center;">[[Miscellaneous | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">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.</span> |
+ | <p class="mw-empty-elt" style="text-align: center;"> </p> | ||
+ | [[File:Sumhorsa.gif|center|Sumhorsa.gif]] | ||
+ | <p style="text-align: center;"><span style="color: #7c00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 26px; text-align: center;">[[Miscellaneous|BACK]]</span></p> |
Latest revision as of 23:28, 8 April 2022
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 2023
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.