Narozny W, Sicko Z, Kot J, Stankiewicz C, Przewozny T, Kuczkowski J
ENT Department Medical University of Gdansk, Poland.
Undersea Hyperb Med. 2005 Mar-Apr;32(2):103-10.
We have investigated the treatment results of hyperbaric oxygen (HBO2) to patients with radiation-induced tissue complications.
Eight patients (1.4%) from 548 with head and neck cancers treated surgically with post- or preoperative radiotherapy or radiotherapy alone in standard doses who developed postradiation complications (6 patients with laryngeal chondroradionecrosis, 1 patient with osteoradionecrosis of the temporal bone, and 1 patient with soft tissue radionecrosis) are presented. To evaluate radiation reactions occuring in the head and neck region, we used the Chandler grading system for classification of postradiation larynx injuries and SOMA/LENT score for classification of postradiation injuries of mucosa of upper aerodigestive tract. Grades I and II in those grading systems are expected side effects of radiation therapy, thus our cases were all in grades III and IV. The HBO2 was performed after failure of the conventional treatment (antibiotics, steroids, topical therapy). The number of HBO2 expositions was from 8 to 39 and the delay to therapy from 2 to 22 months.
Symptoms resolved in all treated patients. Six patients with laryngeal chondroradionecrosis had no symptoms after therapy and in three of them after partial laryngectomy the decannulation was performed. In one patient with mucosal radionecrosis after total laryngectomy, the esophageal fistula was closed and in one patient with osteoradionecrosis of the temporal bone, wound debridement followed.
The authors' experience supports the increasing clinical evidence that HBO2 is an effective adjunct therapy for treatment of complications of irradiation in head and neck area.
我们研究了高压氧（HBO₂）对放射性组织并发症患者的治疗效果。
呈现了548例接受手术治疗的头颈癌患者中的8例（1.4%），这些患者接受了术后或术前放疗或仅接受标准剂量的放疗，出现了放射性并发症（6例喉软骨放射性坏死，1例颞骨放射性骨坏死，1例软组织放射性坏死）。为评估头颈部区域发生的放射反应，我们使用钱德勒分级系统对头颈部放射性损伤进行分类，使用SOMA/LENT评分对上呼吸道消化道黏膜放射性损伤进行分类。在这些分级系统中，I级和II级是放疗的预期副作用，因此我们的病例均为III级和IV级。HBO₂治疗在常规治疗（抗生素、类固醇、局部治疗）失败后进行。HBO₂治疗次数为8至39次，治疗延迟时间为2至22个月。
所有接受治疗的患者症状均得到缓解。6例喉软骨放射性坏死患者治疗后无症状，其中3例在部分喉切除术后拔管。1例全喉切除术后黏膜放射性坏死患者的食管瘘闭合，1例颞骨放射性骨坏死患者进行了伤口清创。
作者的经验支持了越来越多的临床证据，即HBO₂是治疗头颈部区域放疗并发症的有效辅助治疗方法。
