Hyperbaric Oxygen Therapy, An Adjunctive Therapy In Skull Base Osteoradionecrosis Following Nasopharyngeal Carcinoma Treatment: A Systematic Review
Authors List
Ng, Y.H., Changi General Hospital, Singapore
Fong, P.Y., Radhziah, S., Singapore General Hospital, Singapore
Introduction
Skull base osteoradionecrosis (ORN) is a frequent complication secondary to radiation therapy (RT) in nasopharyngeal carcinoma (NPC). Hyperbaric oxygen therapy (HBOT) is one of the treatment options alongside nasal irrigation, systemic antibiotics and surgical debridement1. However, the role of HBOT is not yet well established.
Aim
To determine efficacy of HBOT as an adjunctive therapy in skull base ORN following RT for NPC treatment.
Methods
Search of literature databases was conducted from inception to March 2023. 553 studies of NPC patients with skull base ORN treated with HBOT, either upfront or as adjunct, were included. Of which, 31 were reviewed and 17 were eventually included. Data indicating improvement of skull base ORN and quality of life were extracted.
Results
There is improvement of prevention of wound progression (pooled mean of 63%) and in complete wound re-epithelisation (pooled mean of 46%) in patients who received HBOT. Quality of life in terms of symptom control also showed improvement overall e.g. swallowing (p = 0.011), oral pain (p <0.0001) and sticky saliva (p = 0.01). When used as adjunct following surgical debridement, there is significantly increased wound healing versus upfront therapy (84.8 vs 56.7%, p < 0.0001) but no association with decreased wound or vascularised tissue breakdown. This improvement appears to be more apparent in lateral skull base ORN (success rates of 56-80% in long term coverage of exposed bones) than central skull base ORN, the two most common skull base ORN sites.
Conclusion
HBOT brings about improvement in treatment outcomes in terms of wound healing and quality of life for NPC patients with skull base ORN secondary to RT. The benefits for HBOTÂ are further optimized when adopted as an adjunctive therapy following surgical intervention, with slightly better outcomes in lateral skull base ORN.
References
Cho, S. W., & Won, T. B. (2020). Management of skull base osteoradionecrosis. Korean Journal of Otorhinolaryngology-Head and Neck Surgery, 63(2), 51-58. https://doi.org/10.3342/kjorl-hns.2019.00885
Ng, Y.H., Changi General Hospital, Singapore
Fong, P.Y., Radhziah, S., Singapore General Hospital, Singapore
Introduction
Skull base osteoradionecrosis (ORN) is a frequent complication secondary to radiation therapy (RT) in nasopharyngeal carcinoma (NPC). Hyperbaric oxygen therapy (HBOT) is one of the treatment options alongside nasal irrigation, systemic antibiotics and surgical debridement1. However, the role of HBOT is not yet well established.
Aim
To determine efficacy of HBOT as an adjunctive therapy in skull base ORN following RT for NPC treatment.
Methods
Search of literature databases was conducted from inception to March 2023. 553 studies of NPC patients with skull base ORN treated with HBOT, either upfront or as adjunct, were included. Of which, 31 were reviewed and 17 were eventually included. Data indicating improvement of skull base ORN and quality of life were extracted.
Results
There is improvement of prevention of wound progression (pooled mean of 63%) and in complete wound re-epithelisation (pooled mean of 46%) in patients who received HBOT. Quality of life in terms of symptom control also showed improvement overall e.g. swallowing (p = 0.011), oral pain (p <0.0001) and sticky saliva (p = 0.01). When used as adjunct following surgical debridement, there is significantly increased wound healing versus upfront therapy (84.8 vs 56.7%, p < 0.0001) but no association with decreased wound or vascularised tissue breakdown. This improvement appears to be more apparent in lateral skull base ORN (success rates of 56-80% in long term coverage of exposed bones) than central skull base ORN, the two most common skull base ORN sites.
Conclusion
HBOT brings about improvement in treatment outcomes in terms of wound healing and quality of life for NPC patients with skull base ORN secondary to RT. The benefits for HBOTÂ are further optimized when adopted as an adjunctive therapy following surgical intervention, with slightly better outcomes in lateral skull base ORN.
References
Cho, S. W., & Won, T. B. (2020). Management of skull base osteoradionecrosis. Korean Journal of Otorhinolaryngology-Head and Neck Surgery, 63(2), 51-58. https://doi.org/10.3342/kjorl-hns.2019.00885
