The treatment of carcinoma of the nasopharynx in hyperbaric oxygen: an outside assessment

Rapid Progression of Head and Neck Squamous Carcinoma after Hyperbaric Oxygenation

We present four head and neck cancer patients who apparently had rapid progression of clinically occult disease during or soon after undergoing hyperbaric oxygenation. This led us to review existing knowledge about the interaction of HBO with tumors. The literature can be summarized as follows: 1. HBO is a useful tool in several situations commonly encountered by head and neck surgeons-infections, radionecrosis, and wound-healing problems. 2. The use of HBO as a hypoxic cell sensitizer during radiation therapy has been extensively studied, with evidence supporting only marginal advantage to this logistically difficult undertaking. 3. Most reports regarding the interaction of HBO with transplanted tumor cells suggest no effect on tumor growth or metastases. 4. Studies of chemically induced carcinogenesis are less conclusive. Some evidence supports a role for HBO in enhancing growth of preexisting tumors. Better understanding of the interaction of HBO with existing tumors is required to ensure that informed choices-weighing potential risks and benefits of HBO treatment--may be made by head and neck surgeons and their patients. Further research into the interaction between HBO and tumor cells is warranted.

Hyperbaric oxygen in the radiation treatment of head and neck cancers

Published reports on the use of hyperbaric oxygen in the radiation therapy of head and neck cancer are reviewed. The weight of evidence, from randomised trials, is that it is of clinical value in the control of medium sized head and neck tumours. It is also of value in the treatment of lymph node disease. Four attempts to improve the results of the treatment, by various physiological measures, are reviewed. It is concluded that hyperbaric oxygen may be of use when combined with nitroimidazoles as a radiation sensitiser and warrants further study when combined with induced anaemia, aimed to reduce the tumour cord and prevent repopulation between fractions.

Advanced carcinoma of the nasopharynx. Treatment results

From 1947 through 1977, 93 patients with carcinoma of the nasopharynx were treated. Most (83%) of the patients, had stage IV disease including 9 per cent who had a systemic tumor dissemination. Cervical lymph node metastases were present in 73 (78%) patients. The 5-year actuarial survival for all 93 patients was 13 per cent, 40 for stage II, 18 for stage III and 10 for stage IV patients. The factors with significant influence on survival were Initial Performance Status and T4 disease. The presence of N3 disease was a good indicator of a subsequent systemic tumor spread.