Advertisement

Journal of Neuro-Oncology

, Volume 141, Issue 1, pp 151–158 | Cite as

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

  • Yasmin Aghajan
  • Ian Grover
  • Hamza Gorsi
  • Mark Tumblin
  • John Ross CrawfordEmail author
Clinical Study

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.

Keywords

Hyperbaric oxygen Pediatric brain tumors Cerebral radiation necrosis Effects of radiation 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Ostrom QT, Gittleman H, Liao P et al (2017) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2010–2014. Neuro-oncology 19(suppl_5):v1–v88.  https://doi.org/10.1093/neuonc/nox158 CrossRefGoogle Scholar
  2. 2.
    Levin VA, Bidaut L, Hou P et al (2011) Randomized double-blind placebo-controlled trial of bevacizumab therapy for radiation necrosis of the central nervous system. Int J Radiat Oncol Biol Phys 79(5):1487–1495.  https://doi.org/10.1016/j.ijrobp.2009.12.061 CrossRefGoogle Scholar
  3. 3.
    Drezner N, Hardy KK, Wells E et al (2016) Treatment of pediatric cerebral radiation necrosis: a systematic review. J Neurooncol 130(1):141–148.  https://doi.org/10.1007/s11060-016-2219-5 CrossRefGoogle Scholar
  4. 4.
    Stępień K, Ostrowski RP, Matyja E (2016) Hyperbaric oxygen as an adjunctive therapy in treatment of malignancies, including brain tumours. Med Oncol 33(9):101.  https://doi.org/10.1007/s12032-016-0814-0 CrossRefGoogle Scholar
  5. 5.
    Moen I, Stuhr LE (2012) Hyperbaric oxygen therapy and cancer—a review. Target Oncol 7(4):233–242.  https://doi.org/10.1007/s11523-012-0233-x CrossRefGoogle Scholar
  6. 6.
    Chuba PJ, Aronin P, Bhambhani K et al (1997) Hyperbaric oxygen therapy for radiation-induced brain injury in children. Cancer 80(10):2005–2012CrossRefGoogle Scholar
  7. 7.
    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(11):676–678CrossRefGoogle Scholar
  8. 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
  9. 9.
    Schellart NA, Reits D, van der Kleij AJ, Stalpers LJ (2011) Hyperbaric oxygen treatment improved neurophysiologic performance in brain tumor patients after neurosurgery and radiotherapy: a preliminary report. Cancer 117(15):3434–3444.  https://doi.org/10.1002/cncr.25874 CrossRefGoogle Scholar
  10. 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. 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
  12. 12.
    Marx RE (1983) Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg 41:283–288CrossRefGoogle Scholar
  13. 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
  14. 14.
    Feldmeier JJ, Jelen I, Davolt DA, Valente PT, Meltz ML, Alecu R (1995) Hyperbaric oxygen as a prophylaxis for radiation induced delayed enteropathy. Radiother Oncol 35:138–144CrossRefGoogle Scholar
  15. 15.
    Gallagher KA, Liu ZJ, Xiao M, Chen H, Goldstein LJ, Buerk DG, Nedeau A, Thom SR, Velazquez OC (2007) Diabetic impairments in NO-mediated endothelial progenitor cell mobilization and homing are reversed by hyperoxia and SDF-1 alpha. J Clin Invest 117:1249–1259CrossRefGoogle Scholar
  16. 16.
    Plimpton SR, Stence N, Hemenway M, Hankinson TC, Foreman N, Liu AK (2015) Cerebral radiation necrosis in pediatric patients. Pediatr Hematol Oncol 32(1):78–83.  https://doi.org/10.3109/08880018.2013.791738 CrossRefGoogle Scholar
  17. 17.
    Murphy ES, Merchant TE, Wu S et al (2012) Necrosis after craniospinal irradiation: results from a prospective series of children with central nervous system embryonal tumors. Int J Radiat Oncol Biol Phys 83(5):e655–e660CrossRefGoogle Scholar
  18. 18.
    Gunther JR, Sato M, Chintagumpala M et al (2015) Imaging changes in pediatric intracranial ependymoma patients treated with proton beam radiation therapy compared to intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 93(1):54–63CrossRefGoogle Scholar
  19. 19.
    Indelicato DJ, Flampouri S, Rotondo RL et al (2014) Incidence and dosimetric parameters of pediatric brainstem toxicity following proton therapy. Acta Oncol 53:1298–1304CrossRefGoogle Scholar
  20. 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. 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
  22. 22.
    Kohshi K, Kinoshita Y, Imada H et al (1999) Effects of radiotherapy after hyperbaric oxygenation on malignant gliomas. Br J Cancer 80(1–2):236–241.  https://doi.org/10.1038/sj.bjc.6690345 CrossRefGoogle Scholar
  23. 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
  24. 24.
    Suzuki Y, Tanaka K, Negishi D, Shimizu M, Yoshida Y, Hashimoto T, Yamazaki H (2009) Pharmacokinetic investigation of increased efficacy against malignant gliomas of carboplatin combined with hyperbaric oxygenation. Neurol Med Chir 49(5):193–197 (discussion 197)CrossRefGoogle Scholar
  25. 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

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Yasmin Aghajan
    • 1
  • Ian Grover
    • 2
  • Hamza Gorsi
    • 3
    • 4
  • Mark Tumblin
    • 4
    • 5
  • John Ross Crawford
    • 3
    • 4
    • 5
    Email author
  1. 1.University of California San Diego School of MedicineLa JollaUSA
  2. 2.Division of Hyperbaric Medicine and Wound Care, Department of Emergency MedicineUniversity of California San Diego Medical SystemSan DiegoUSA
  3. 3.Department of NeurosciencesUniversity of California San DiegoLa JollaUSA
  4. 4.Rady Children’s HospitalSan DiegoUSA
  5. 5.Division of Hematology-Oncology, Department of PediatricsUniversity of California San DiegoLa JollaUSA

Personalised recommendations