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British Journal of Cancer logoLink to British Journal of Cancer
. 1999 Apr;80(1-2):236–241. doi: 10.1038/sj.bjc.6690345

Effects of radiotherapy after hyperbaric oxygenation on malignant gliomas

K Kohshi 1,4, Y Kinoshita 1, H Imada 2, N Kunugita 2, H Abe 3, H Terashima 2, N Tokui 5, S Uemura 6
PMCID: PMC2363018  PMID: 10390002

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. © 1999 Cancer Research Campaign

Keywords: malignant glioma, hyperbaric oxygenation, radiation therapy, clinical trials

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Selected References

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  1. Barker F. G., 2nd, 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. Radiation response and survival time in patients with glioblastoma multiforme. J Neurosurg. 1996 Mar;84(3):442–448. doi: 10.3171/jns.1996.84.3.0442. [DOI] [PubMed] [Google Scholar]
  2. Bernsen H. J., Rijken P. F., Oostendorp T., van der Kogel A. J. Vascularity and perfusion of human gliomas xenografted in the athymic nude mouse. Br J Cancer. 1995 Apr;71(4):721–726. doi: 10.1038/bjc.1995.141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Burger P. C., Green S. B. Patient age, histologic features, and length of survival in patients with glioblastoma multiforme. Cancer. 1987 May 1;59(9):1617–1625. doi: 10.1002/1097-0142(19870501)59:9<1617::aid-cncr2820590916>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  4. Cade I. S., McEwen J. B. Clinical trials of radiotherapy in hyperbaric oxygen at Portsmouth, 1964--1976. Clin Radiol. 1978 May;29(3):333–338. doi: 10.1016/s0009-9260(78)80081-6. [DOI] [PubMed] [Google Scholar]
  5. Chang C. H. Hyperbaric oxygen and radiation therapy in the management of glioblastoma. Natl Cancer Inst Monogr. 1977 Dec;46:163–169. [PubMed] [Google Scholar]
  6. Chaplin D. J., Durand R. E., Olive P. L. Acute hypoxia in tumors: implications for modifiers of radiation effects. Int J Radiat Oncol Biol Phys. 1986 Aug;12(8):1279–1282. doi: 10.1016/0360-3016(86)90153-7. [DOI] [PubMed] [Google Scholar]
  7. Curran W. J., Jr, 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. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst. 1993 May 5;85(9):704–710. doi: 10.1093/jnci/85.9.704. [DOI] [PubMed] [Google Scholar]
  8. Dische S. What have we learnt from hyperbaric oxygen? Radiother Oncol. 1991;20 (Suppl 1):71–74. doi: 10.1016/0167-8140(91)90191-i. [DOI] [PubMed] [Google Scholar]
  9. Dowling S., Fischer J. J., Rockwell S. Fluosol and hyperbaric oxygen as an adjunct to radiation therapy in the treatment of malignant gliomas: a pilot study. Biomater Artif Cells Immobilization Biotechnol. 1992;20(2-4):903–905. doi: 10.3109/10731199209119738. [DOI] [PubMed] [Google Scholar]
  10. Fowler J. F. The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol. 1989 Aug;62(740):679–694. doi: 10.1259/0007-1285-62-740-679. [DOI] [PubMed] [Google Scholar]
  11. GRAY L. H., CONGER A. D., EBERT M., HORNSEY S., SCOTT O. C. The concentration of oxygen dissolved in tissues at the time of irradiation as a factor in radiotherapy. Br J Radiol. 1953 Dec;26(312):638–648. doi: 10.1259/0007-1285-26-312-638. [DOI] [PubMed] [Google Scholar]
  12. Groshar D., McEwan A. J., Parliament M. B., Urtasun R. C., Golberg L. E., Hoskinson M., Mercer J. R., Mannan R. H., Wiebe L. I., Chapman J. D. Imaging tumor hypoxia and tumor perfusion. J Nucl Med. 1993 Jun;34(6):885–888. [PubMed] [Google Scholar]
  13. Helmlinger G., Yuan F., Dellian M., Jain R. K. Interstitial pH and pO2 gradients in solid tumors in vivo: high-resolution measurements reveal a lack of correlation. Nat Med. 1997 Feb;3(2):177–182. doi: 10.1038/nm0297-177. [DOI] [PubMed] [Google Scholar]
  14. Henk J. M., Kunkler P. B., Smith C. W. Radiotherapy and hyperbaric oxygen in head and neck cancer. Final report of first controlled clinical trial. Lancet. 1977 Jul 16;2(8029):101–103. doi: 10.1016/s0140-6736(77)90116-7. [DOI] [PubMed] [Google Scholar]
  15. Henk J. M. 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. 1986 Aug;12(8):1339–1341. doi: 10.1016/0360-3016(86)90167-7. [DOI] [PubMed] [Google Scholar]
  16. Ito M., Lammertsma A. A., Wise R. J., Bernardi S., Frackowiak R. S., Heather J. D., McKenzie C. G., Thomas D. G., Jones T. Measurement of regional cerebral blood flow and oxygen utilisation in patients with cerebral tumours using 15O and positron emission tomography: analytical techniques and preliminary results. Neuroradiology. 1982;23(2):63–74. doi: 10.1007/BF00367239. [DOI] [PubMed] [Google Scholar]
  17. JAMIESON D., VANDENBRENK H. A. MEASUREMENT OF OXYGEN TENSIONS IN CEREBRAL TISSUES OF RATS EXPOSED TO HIGH PRESSURES OF OXYGEN. J Appl Physiol. 1963 Sep;18:869–876. doi: 10.1152/jappl.1963.18.5.869. [DOI] [PubMed] [Google Scholar]
  18. Kayama T., Yoshimoto T., Fujimoto S., Sakurai Y. Intratumoral oxygen pressure in malignant brain tumor. J Neurosurg. 1991 Jan;74(1):55–59. doi: 10.3171/jns.1991.74.1.0055. [DOI] [PubMed] [Google Scholar]
  19. Kohshi K., Kinoshita Y., Terashima H., Konda N., Yokota A., Soejima T. Radiotherapy after hyperbaric oxygenation for malignant gliomas: a pilot study. J Cancer Res Clin Oncol. 1996;122(11):676–678. doi: 10.1007/BF01209031. [DOI] [PubMed] [Google Scholar]
  20. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966 Mar;50(3):163–170. [PubMed] [Google Scholar]
  21. Mineura K., Sasajima T., Kowada M., Ogawa T., Hatazawa J., Shishido F., Uemura K. Perfusion and metabolism in predicting the survival of patients with cerebral gliomas. Cancer. 1994 May 1;73(9):2386–2394. doi: 10.1002/1097-0142(19940501)73:9<2386::aid-cncr2820730923>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
  22. Murovic J., Turowski K., Wilson C. B., Hoshino T., Levin V. Computerized tomography in the prognosis of malignant cerebral gliomas. J Neurosurg. 1986 Dec;65(6):799–806. doi: 10.3171/jns.1986.65.6.0799. [DOI] [PubMed] [Google Scholar]
  23. Parliament M. B., Franko A. J., Allalunis-Turner M. J., Mielke B. W., Santos C. L., Wolokoff B. G., Mercer J. R. Anomalous patterns of nitroimidazole binding adjacent to necrosis in human glioma xenografts: possible role of decreased oxygen consumption. Br J Cancer. 1997;75(3):311–318. doi: 10.1038/bjc.1997.52. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Rampling R., Cruickshank G., Lewis A. D., Fitzsimmons S. A., Workman P. Direct measurement of pO2 distribution and bioreductive enzymes in human malignant brain tumors. Int J Radiat Oncol Biol Phys. 1994 Jun 15;29(3):427–431. doi: 10.1016/0360-3016(94)90432-4. [DOI] [PubMed] [Google Scholar]
  25. Rasey J. S., Koh W. J., Evans M. L., Peterson L. M., Lewellen T. K., Graham M. M., Krohn K. A. 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. 1996 Sep 1;36(2):417–428. doi: 10.1016/s0360-3016(96)00325-2. [DOI] [PubMed] [Google Scholar]
  26. Sealy A., Hockly J., Shepstone B. The treatment of malignant melanoma with cobalt and hyperbaric oxygen. Clin Radiol. 1974 Apr;25(2):211–215. doi: 10.1016/s0009-9260(74)80054-1. [DOI] [PubMed] [Google Scholar]
  27. Stewart P. A., Farrell C. L., Del Maestro R. F. 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. 1991 Jul-Aug;60(1-2):125–130. doi: 10.1080/09553009114551701. [DOI] [PubMed] [Google Scholar]
  28. THOMLINSON R. H., GRAY L. H. The histological structure of some human lung cancers and the possible implications for radiotherapy. Br J Cancer. 1955 Dec;9(4):539–549. doi: 10.1038/bjc.1955.55. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Tyler J. L., Diksic M., Villemure J. G., Evans A. C., Meyer E., Yamamoto Y. L., Feindel W. Metabolic and hemodynamic evaluation of gliomas using positron emission tomography. J Nucl Med. 1987 Jul;28(7):1123–1133. [PubMed] [Google Scholar]
  30. Valk P. E., Mathis C. A., Prados M. D., Gilbert J. C., Budinger T. F. Hypoxia in human gliomas: demonstration by PET with fluorine-18-fluoromisonidazole. J Nucl Med. 1992 Dec;33(12):2133–2137. [PubMed] [Google Scholar]
  31. Watson E. R., Halnan K. E., Dische S., Saunders M. I., Cade I. S., McEwen J. B., Wiernik G., Perrins D. J., Sutherland I. Hyperbaric oxygen and radiotherapy: a Medical Research Council trial in carcinoma of the cervix. Br J Radiol. 1978 Nov;51(611):879–887. doi: 10.1259/0007-1285-51-611-879. [DOI] [PubMed] [Google Scholar]
  32. Wesseling P., van der Laak J. A., de Leeuw H., Ruiter D. J., Burger P. C. Quantitative immunohistological analysis of the microvasculature in untreated human glioblastoma multiforme. Computer-assisted image analysis of whole-tumor sections. J Neurosurg. 1994 Dec;81(6):902–909. doi: 10.3171/jns.1994.81.6.0902. [DOI] [PubMed] [Google Scholar]
  33. Wood J. R., Green S. B., Shapiro W. R. The prognostic importance of tumor size in malignant gliomas: a computed tomographic scan study by the Brain Tumor Cooperative Group. J Clin Oncol. 1988 Feb;6(2):338–343. doi: 10.1200/JCO.1988.6.2.338. [DOI] [PubMed] [Google Scholar]
  34. Yoshii Y., Sugiyama K. Intercapillary distance in the proliferating area of human glioma. Cancer Res. 1988 May 15;48(10):2938–2941. [PubMed] [Google Scholar]

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