Conclusion

Few controlled trials are available concerning tissues radionecrosis. Complications are often not assessed with either the RTOG/ EORTC or SOMA/LENT scales, the duration of symptom improvement is not specified, and endpoints are not clearly defined. A small number of studies have reported facts about quality of life. It is therefore difficult to draw a guiding principle. Nevertheless, during the European Consensus Conference organised jointly by the European Society for Therapeutic Radiotherapy and Oncology (ESTRO) and the European Committee for Hyperbaric Medicine (ECHM), held in Lisbon, Portugal in October 2001, the international jury came to the conclusion that some indications have a higher evidence level than others due to the presence of prospective studies and the significant number of positive retrospective studies such haemorrhagic cystitis resistant to conventional treatments254 (table 2.2.8-4). These recommendations are however not supported the highest level of evidence based on several randomised trials. In future, the setting up of multicentre controlled trials to compensate for the scarcity of these complications may bring an answer to these issues. This will require a close collaboration between physicians concerned with hyperbaric medicine and radiation oncologists.

Table 2.2.8-4. Indications of HBO in the treatment of radio-induced lesions in normal tissues254

Recommendation grade

Indication

Level 2 - convincing grade

Radionecrosis of the mandible

Radiation Cystitis of the bladder resistant to conservative measures

Tooth extraction in irradiated tissues (preventive action) Radionecrosis of other bones Radiation-induced proctitis and enteritis Radiation-induced lesions of soft tissues Surgery and implants in heavily irradiated tissues (preventive action)

Radiation-induced lesions of the larynx Radiation-induced lesions of the central nervous system. Radiation-induced plexopathy_

Level 3 - evidence of beneficial action but weakly supported

Level 4 - anecdoctal evidence

No evidence to support

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