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Use of hyperbaric oxygen therapy in pediatric neuro-oncology: a single institutional experience

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Abstract

Introduction

Hyperbaric oxygen therapy (HBOT) has been utilized as adjunctive treatment of CNS tumors and for radiation necrosis (RN) with reported success. The safety and efficacy in pediatric patients is less understood.

Methods

Seven patients (ages 10–23 years, six females) were treated with HBOT (3–60 sessions) for either RN (n = 5) or tumor-associated edema (n = 2). Tumor diagnosis included low-grade glioma (n = 4, two with neurofibromatosis type 1), meningioma (n = 1), medulloblastoma (n = 1) and secondary high grade glioma (n = 1). Prior therapies included: surgery (n = 4), chemotherapy (n = 4) and radiation (N = 5: four focal, one craniospinal). Three underwent biopsy: one confirming RN, one high-grade glioma, and one low-grade glioma. Patients were assessed for clinical and radiographic changes post HBOT.

Results

Median time to clinical and radiographic presentation was 8.5 months (range 6 months–11 years) in those who had prior radiation. Clinical improvement after HBOT (median: 40 sessions) was observed in four of seven patients. Symptoms were stable in two and worsened in one patient. Radiographic improvement was seen in four patients; three had radiographic disease progression. In the subgroup treated for presumed and biopsy-confirmed RN (n = 5), four of five (80%) had clinical and radiographic improvement. There were no long-term adverse events due to HBOT.

Conclusions

HBOT is safe and well-tolerated in pediatric and young adult patients with CNS tumors. Clinical and radiographic improvements were observed in over half of patients. Clinical trials are needed to establish safety and efficacy of HBOT as adjunct therapy in pediatric CNS tumors.

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Authors and Affiliations

  1. University of California San Diego School of Medicine, La Jolla, CA, USA

    Yasmin Aghajan

  2. Division of Hyperbaric Medicine and Wound Care, Department of Emergency Medicine, University of California San Diego Medical System, San Diego, CA, USA

    Ian Grover

  3. Department of Neurosciences, University of California San Diego, La Jolla, CA, USA

    Hamza Gorsi & John Ross Crawford

  4. Rady Children’s Hospital, San Diego, CA, USA

    Hamza Gorsi, Mark Tumblin & John Ross Crawford

  5. Division of Hematology-Oncology, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA

    Mark Tumblin & John Ross Crawford

Authors
  1. Yasmin Aghajan
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  2. Ian Grover
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  3. Hamza Gorsi
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  4. Mark Tumblin
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  5. John Ross Crawford
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Correspondence to John Ross Crawford.

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Aghajan, Y., Grover, I., Gorsi, H. et al. Use of hyperbaric oxygen therapy in pediatric neuro-oncology: a single institutional experience. J Neurooncol 141, 151–158 (2019). https://doi.org/10.1007/s11060-018-03021-x

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  • DOI: https://doi.org/10.1007/s11060-018-03021-x

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