Osteoradionecrosis and Hyperbaric Oxygen Theraphy
Both bone and soft tissue suffer damage from therapeutic radiation. Bone is nearly twice as dense as soft tissue and therefore absorbs a proportionately larger dose of radiation.
High doses of radiation cause bone death due to suppression of oxygen uptake and destruction of the surrounding blood supply. Destruction of the bone building mechanisms causes osteoporosis and can eventually ORN.
Clinically significant osteonecrosis usually develops over a period of four months to several years. ORN becomes clinically significant when it develops at four sites in the body: chest wall, mandible, pelvis, vertebral column and skull. Damage to the ribs and the sternum can result following radiation therapy for tumours of the breast, chest wall or lung. Fractures in irradiated ribs can result from coughing, or even from deep breathing. Doses of radiation required for adequate tumour kill in head and neck cancers are accompanied byhigh incidences of ORN especially in the mandible.
During the 1960‘s Hyperbaric Oxygen Therapy (HBOT) was first proposed as a treatment for cancer and other conditions. In the late 1970’s Neck and Head Surgeons came to recognise the value of HBOT in treating damage of the maxilla and mandible occurring during radiation treatments. Research has shown that HBOT is effective especially when used in conjunction with conventional treatments for the prevention and treatment of osteoradionecrosis.
How it works
HBOT acts through both mechanical (pressure) and physiological (oxygen) components. Hyperbaric oxygen therapy appears to help in salvaging tissue damaged by radiation therapy by stimulating angioneogenesis in tissue that is even marginally viable.
In a protocol developed by Marx, 58 patients received HBOT followed by debridement. All 58patients studied had resolution of symptoms, with good results on long term follow up, and others have now corroborated these results.
The 1990 consensus paper of the National Cancer institute on the Oral Complications of Cancer therapies states: ‘The treatment of ORN with antibiotics and surgical debridement frequently fails, with progressive involvement of the remaining mandible. The keystone of the treatment of ORN is the provision of adequate tissue oxygenation in the damaged bone. This is best done by hyperbaric oxygen therapy (HBOT)’.
Please contact us at Pure Oxygen to discuss treatment protocols. We will in many cases be working in conjunction with your oncology consultant.