Hyperbaric Oxygen Therapy as an Alternative Therapeutic Option for Radiation-Induced Necrosis Following Radiotherapy for Intracranial Pathologies

• Published in: World neurosurgery 2024-06, Vol.186, p.51-61
• Main Authors: Hajikarimloo, Bardia, Kavousi, Shahin, Jahromi, Ghazaleh Ghaffaripour, Mehmandoost, Mahdi, Oraee-Yazdani, Saeed, Fahim, Farzan
• Format: Article
• Language: English
• Subjects: Adjuvant therapy; Barotrauma; Brain Neoplasms - radiotherapy; Brain Neoplasms - therapy; Humans; Hyperbaric oxygen therapy; Hyperbaric Oxygenation - methods; Intracranial Arteriovenous Malformations - radiotherapy; Intracranial Arteriovenous Malformations - therapy; Necrosis - etiology; Outcomes; Radiation Injuries - etiology; Radiation Injuries - therapy; Radiation necrosis; Radiotherapy; Radiotherapy - adverse effects
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.01.161

Radiotherapy (RT) is a feasible adjuvant therapeutic option for managing intracranial pathologies. One of the late complications of RT that frequently develops within months following RT is radiation necrosis (RN). Corticosteroids are the first-line therapeutic option for RNs; however, in case of unfavorable outcomes or intolerability, several other options, including bevacizumab, laser interstitial thermal therapy, surgery, and hyperbaric oxygen therapy (HBOT). Our goal was to investigate the feasibility and efficacy of the application of HBOT in RNs following RT and help physicians make decisions based on the latest data in the literature. We provide a comprehensive review of the literature on the current issues of utilization of HBOT in RNs. We included 11 studies with a total of 46 patients who underwent HBOT. Most of the cases were diagnosed with brain tumors or arteriovenous malformations. Improvement was achieved in most of the cases. HBOT is a noninvasive therapeutic intervention that can play a role in adjuvant therapy concurrent with RT and chemotherapy and treating RNs. HBOT resolves the RN through 3 mechanisms, including angiogenesis, anti-inflammatory modulation, and cellular repair. Previous studies demonstrated that HBOT is a feasible and well-tolerated therapeutic option that has shown promising results in improving clinical and radiological outcomes in intracranial RNs. Complications of HBOT are usually mild and reversible. HBOT is a feasible and effective therapeutic option in steroid-refractory RNs and is associated with favorable outcomes and a low rate of side effects. [Display omitted]