A Cochrane review [Abstract] 1 included 14 studies with a total of 753 subjects investigating the use of hyperbaric oxygen therapy (HBOT) for tissue suffering from radiation tissue injury (LRTI). There was a significantly improved probability of attaining mucosal cover with osteoradionecrosis (ORN) with the administration of HBOT (RR 1.3, 95% CI 1.1 to 1.6; 3 studies, n=246; NNT=5). There was also moderate quality evidence of a significantly improved chance of wound breakdown without HBOT following operative treatment for ORN (RR 4.2; 95% CI 1.1 to 16.8, P value = 0.04, NNTB 4; 264 participants, 2 studies). From single studies there was a significantly increased chance of improvement or cure following HBOT for radiation proctitis (RR 1.72, 95% CI 1.0 to 2.9, 1 study, n=119; NNT = 5), and following both surgical flaps (RR 8.7, 95% CI 2.7 to 27.5, 1 study, n=160; NNT = 4) and hemimandibulectomy (RR 1.4, 95% CI 1.1 to 1.8, 1 study, n=104; NNT = 5). There was also a significantly improved probability of healing irradiated tooth sockets following dental extraction (RR 1.4, 95% CI 1.1 to 1.7, 1 study, n=74; NNT = 4). However, another Cochrane review Hyperbaric Oxygen (Hbo) Therapy for Irradiated Patients Who Require Dental Implants found no benefit of HBOT for patients who require dental implants after radiotherapy.
There was no evidence of benefit in clinical outcomes with established radiation injury to neural tissue, and no data reported on the use of HBOT to treat other manifestations of LRTI. These trials did not report adverse effects.
Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals) and by inconsistency (variability in results across studies).
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