Abstract
The purpose of this non-randomized trial was to evaluate the efficacy of radiotherapy combined with hyperbaric oxygen (HBO) in patients with malignant glioma. Between 1987 and 1997, 29 patients in whom computerized tomography (CT) or magnetic resonance imaging (MRI) scans showed post-operative residual tumours were locally irradiated with nitrosourea-based chemotherapy. Treatments were consecutively combined with HBO at two institutions since 1991 and 1993. Fifteen patients were irradiated daily after HBO, and the periods of time from decompression to irradiation were within 15 and 30 min in 11 and four patients respectively. Fourteen other patients were treated without HBO. Tumour responses were assessed by CT or MRI scans and survival times were compared between the treated groups. In the HBO group, 11 of 15 patients (73%) showed ≥ 50% tumour regression. All responders were irradiated within 15 min after decompression. In the non-HBO group, four of 14 patients (29%) showed tumour regression. The median survivals in patients with and without HBO were 24 and 12 months, respectively, and were significantly different (P < 0.05). No serious side-effects were observed in the HBO patients. In conclusion, irradiation after HBO seems to be a useful form of treatment for malignant gliomas, but irradiation should be administered immediately after decompression.
Similar content being viewed by others
Article PDF
Change history
16 November 2011
This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication
References
Barker, F. G., Prados, M. D., Chang, S. M., Gutin, P. H., Lamborn, K. R., Larson, D. A., Malec, M. K., McDermott, M. W., Sneed, P. K., Wara, W. M. & Wilson, C. B. (1996) Radiation response and survival time in patients with glioblastoma multiforme. J Neurosurg 84: 442–448.
Bernsen, HJJA, Rijken, PFJW, Oostendorp, T. & van der Kogel, A. J. (1995) Vascularity and perfusion of human gliomas xenografted in the athymic nude mouse. Br J Cancer 71: 721–726.
Burger, P. C. & Green, S. B. (1987) Patient age, histologic features, and length of survival in patients with glioblastoma multiforme. Cancer 59: 1617–1625.
Cade, I. S. & McEwen, J. B. (1978) Clinical trials of radiotherapy in hyperbaric oxygen at Portsmouth, 1964–1976. Clin Radiol 29: 333–338.
Chang, C. H. (1977) Hyperbaric oxygen and radiation therapy in the management of glioblastoma. Natl Cancer Inst Monogr 46: 163–169.
Chaplin, D. J., Durand, R. E. & Olive, P. L. (1986) Acute hypoxia in tumors: implications for modifiers of radiation effects. Int J Radiat Oncol Biol Phys 12: 1279–1282.
Cox, D. R. (1972) Regression models and life tables. J R Stat Soc 34: 187–220.
Curran, W. J., Scott, C. B., Horton, J., Nelson, J. S., Weinstein, A. S., Fischbach, A. J., Chang, C. H., Rotman, M., Asbell, S. O., Krisch, R. E. & Nelson, D. F. (1993) Recursive partitioning analysis of prognostic factors in three radiation therapy oncology group malignant glioma trials. J Natl Cancer Inst 85: 704–710.
Dische, S. (1991) What have we learnt from hyperbaric oxygen?. Radiother Oncol 20: 71–74.
Dowling, S., Fischer, J. J. & Rockwell, S. (1992) Fluosol and hyperbaric oxygen as an adjunct to radiation therapy in the treatment of malignant gliomas: a pilot study. Biomater Artif Cells Immobilization Biotechnol 20: 903–905.
Fowler, J. F. (1989) The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol 62: 679–694.
Gray, L. H., Conger, A. D., Ebert, M., Hornsey, A. & Scott, O. C. A. (1953) The concentration of oxygen dissolved in tissues at the time of irradiation as a factor in radiotherapy. Br J Radiol 26: 638–648.
Groshar, D., McEwan, A. J. B., Parliament, M. B., Urtasun, R. C., Golberg, L. E., Hoskinson, M., Mercer, J. R., Mannan, R. H., Wiebe, L. I. & Chapman, J. D. (1993) Imaging tumor hypoxia and tumor perfusion. J Nucl Med 34: 885–888.
Hall, E. J. (1994). Radiobiology for the Radiologist, pp. 133–152. Lippincott: Philadelphia
Helmlinger, G., Yuan, F., Dellian, M. & Jain, R. K. (1997) Interstitial pH and pO2 gradients in solid tumors in vivo: high-resolution measurements reveal a lack of correlation. Nature Med 3: 177–182.
Henk, J. M. (1986) Late results of a trial of hyperbaric oxygen and radiotherapy in head and neck cancer: a rationale for hypoxic cell sensitizers?. Int J Radiat Oncol Biol Phys 12: 1339–1341.
Henk, J. M., Kunkler, P. B. & Smith, C. W. (1977) Radiotherapy and hyperbaric oxygen in head and neck cancer. Final report of first controlled clinical trial. Lancet 2: 101–103.
Ito, M., Lammertsma, A. A., Wise, R. J. S., Bernardi, S., Frackowiak, R., Hckenzie, C., Thomas, D. G. T. & Jones, T. (1982) Measurement of regional cerebral blood flow and oxygen utilization in patients with cerebral tumours using 15O and positron emission tomography: analytical techniques and preliminary results. Neuroradiology 23: 63–74.
Jain, K. K. (1990). Textbook of Hyperbaric Medicine, pp. 408–417. Hogrefe & Huber Publishers: Toronto
Jamieson, D. & van den Brenk, H. A. S. (1963) Measurement of oxygen tensions in cerebral tissues of rats exposed to high pressures of oxygen. J Appl Physiol 18: 869–876.
Kaplan, E. L. & Meier, P. (1958) Non-parametric estimation from incomplete observations. J Am Stat Assoc 53: 457–481.
Karnofsky, D. A., Abelmann, W. H. & Craver, L. S. (1948) The use of the nitrogen mustards in the palliative treatment of carcinoma: with particular reference to bronchogenic carcinoma. Cancer 1: 634–656.
Kayama, T., Yoshimoto, T., Fujimoto, S. & Sakurai, Y. (1991) Intratumoral oxygen pressure in malignant brain tumor. J Neurosurg 74: 55–59.
Kleihues, P., Burger, P. C. & Scheithauer, B. W. (1993). Histological Typing of Tumours of the Central Nervous System, 2nd Ed. Springer-Verlag: Berlin
Kohshi, K., Kinoshita, Y., Terashima, H., Konda, N., Yokota, A. & Soejima, T. (1996) Radiotherapy after hyperbaric oxygenation for malignant gliomas: a pilot study. J Cancer Res Clin Oncol 122: 676–678.
Mantel, N. (1966) Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50: 163–170.
Mineura, K., Sasajima, T., Kowada, M., Ogawa, T., Hatazawa, J., Shishido, F. & Uemura, K. (1994) Perfusion and metabolism in predicting the survival of patients with cerebral gliomas. Cancer 73: 2386–2394.
Murovic, J., Turowski, K., Wilson, C. B., Hoshino, T. & Levin, V. (1986) Computerized tomography in the prognosis of malignant cerebral gliomas. J Neurosurg 65: 799–806.
Parliament, M. B., Franko, A. J., Allalunis-Turner, M. J., Mielke, B. W., Santos, C. L., Wolokoff, B. G. & Mercer, J. R. (1997) Anomalous patterns of nitroimidazole binding adjacent to necrosis in human glioma xenografts: possible role of decreased oxygen consumption. Br J Cancer 75: 311–318.
Rampling, R., Cruickshank, G., Lewis, A. D., Fitzsimmons, S. A. & Workman, P. (1994) Direct measurement of pO2 distribution and bioreductive enzymes in human malignant brain tumors. Int J Radiat Oncol Biol Phys 29: 427–431.
Rasey, J. S., Koh, W-J, Evans, M. L., Peterson, L. M., Lewellen, T. K., Graham, M. M. & Krohn, K. A. (1996) Quantifying regional hypoxia in human tumors with positron emission tomography of [18F]fluoromisonidazole: a pretherapy study of 37 patients. Int J Radiat Oncol Biol Phys 36: 417–428.
Sealy, A., Hockly, J. & Shepstone, B. (1974) The treatment of malignant melanoma with cobalt and hyperbaric oxygen. Clin Radiol 25: 211–215.
Stewart, P. A., Farrell, C. L. & Del Maestro, R. F. (1991) The effect of cellular microenvironment on vessels in the brain. Part 1: vessel structure in tumour, peritumour and brain from humans with malignant glioma. Int J Radiat Biol 60: 125–130.
Thomlinson, R. H. & Gray, L. H. (1955) The histological structure of some human lung cancers and the possible implications for radiotherapy. Br J Cancer 9: 539–549.
Tyler, J. L., Diksic, M., Villemure, J-G, Evans, A. C., Meyer, E., Yamamoto, Y. L. & Feindel, W. (1987) Metabolic and hemodynamic evaluation of gliomas using positron emission tomography. J Nucl Med 28: 1123–1133.
Valk, P. E., Mathis, C. A., Prados, M. D., Gilbert, J. C. & Budinger, T. F. (1992) Hypoxia in human gliomas: demonstration by PET with fluorine-18 fluoromisonidazole. J Nucl Med 33: 2133–2137.
Watson, E. R., Halnan, K. E., Dische, S., Saunders, M. I., Cade, I. S., McEwen, J. B., Wiernik, G., Perrins, D. J. & Sutherland, I. (1978) Hyperbaric oxygen and radiotherapy: a Medical Research Council trial in carcinoma of the cervix. Br J Radiol 51: 879–887.
Wells, C. H., Goodpasture, J. E., Horrigan, D. J. & Hart, G. B. (1977). Tissue gas measurements during hyperbaric oxygen exposure. In Procceedings of the 6th International Congress on Hyperbaric Medicine, Smith G (ed), pp. 118–124. Aberdeen University Press: Aberdeen
Wesseling, P., van der Laak, JAWM, De Leeuw, H., Ruiter, D. J. & Burger, P. C. (1994) Quantitative immunohistological analysis of the microvasculature in untreated human glioblastoma multiforme. J Neurosurg 81: 902–909.
Wood, J. R., Green, S. B. & Shapiro, W. R. (1988) The prognostic importance of tumor size in malignant gliomas: a computed tomographic scan study by the Brain Tumor Cooperative Group. J Clin Oncol 6: 338–343.
Yoshii, Y. & Sugiyama, K. (1988) Intercapillary distance in the proliferating area of human glioma. Cancer Res 48: 2938–2941.
Author information
Authors and Affiliations
Rights and permissions
From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
About this article
Cite this article
Kohshi, K., Kinoshita, Y., Imada, H. et al. Effects of radiotherapy after hyperbaric oxygenation on malignant gliomas. Br J Cancer 80, 236–241 (1999). https://doi.org/10.1038/sj.bjc.6690345
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.bjc.6690345
Keywords
This article is cited by
-
Use of hyperbaric oxygen therapy in pediatric neuro-oncology: a single institutional experience
Journal of Neuro-Oncology (2019)
-
Temporal changes in tumor oxygenation and perfusion upon normo- and hyperbaric inspiratory hyperoxia
Strahlentherapie und Onkologie (2016)
-
Hyperbaric oxygen as an adjunctive therapy in treatment of malignancies, including brain tumours
Medical Oncology (2016)
-
Hyperbaric oxygen and cancer: more complex than we expected
Targeted Oncology (2013)
-
Old but new methods in radiation oncology: hyperbaric oxygen therapy
International Journal of Clinical Oncology (2013)
