Use of hyperbaric oxygen therapy in pediatric neuro-oncology: a single institutional experience
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.
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.
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.
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.
KeywordsHyperbaric oxygen Pediatric brain tumors Cerebral radiation necrosis Effects of radiation
Conflict of interest
The authors declare that they have no conflict of interest.
- 8.Wanebo JE, Kidd GA, King MC, Chung TS (2009) Hyperbaric oxygen therapy for treatment of adverse radiation effects after stereotactic radiosurgery of arteriovenous malformations: case report and review of literature. Surg Neurol 72(2):162–167. https://doi.org/10.1016/j.surneu.2008.03.037 (discussion 167–168)CrossRefGoogle Scholar
- 10.Hart GB, Strauss MB (1987) Central nervous system oxygen toxicity in a clinical setting. In: Bove AA, Bachrach AJ, Greenbaum LJ (eds) Undersea and hyperbaric physiology IX. Proceedings of the ninth international symposium on underwater and hyperbaric physiology. Undersea and Hyperbaric Medical Society, Bethesda, pp 695–699Google Scholar
- 11.Plafki C, Peters P, Almeling M, Welslau W, Busch R (2000) Complications and side effects of hyperbaric oxygen therapy. Aviat Space Environ Med 71(2):119–124Google Scholar
- 13.Feldmeier JJ, Davolt DA, Court WS, Onoda JM, Alecu R (1998) Histologic morphometry confirms a prophylactic effect for hyperbaric oxygen in the prevention of delayed radiation enteropathy. Undersea Hyperb Med 25(2):93–97Google Scholar
- 20.Beppu T, Tanaka K, Kohshi K (2009) Utility of hyperbaric oxygenation in radiotherapy for malignant brain tumors—a literature review. Brain Nerve 61(6):677–681Google Scholar
- 21.Feldmeier JJ (2001) Hyperbaric oxygen: does it have a cancer causing or growth enhancing effect. In: Proceedings of the consensus conference sponsored by the European society for therapeutic radiology and oncology and the European committee for hyperbaric medicine. Portugal, pp 129–146Google Scholar
- 23.Ogawa K, Ishiuchi S, Inoue O et al (2012) Phase II trial of radiotherapy after hyperbaric oxygenation with multiagent chemotherapy (procarbazine, nimustine, and vincristine) for high-grade gliomas: long-term results. Int J Radiat Oncol Biol Phys 82(2):732–738. https://doi.org/10.1016/j.ijrobp.2010.12.070 CrossRefGoogle Scholar
- 25.Kohshi K, Beppu T, Tanaka K, Ogawa K, Inoue O, Kukita I, Clarke RE (2013) Potential roles of hyperbaric oxygenation in the treatments of brain tumors. Undersea Hyperb Med 40(4):351–362Google Scholar