Enomoto Mitsuhiro, Yagishita Kazuyoshi, Okuma Kae, Oyaizu Takuya, Kojima Yasushi, Okubo Atsushi, Maeda Takuma, Miyamoto Satoko, Okawa Atsushi
Hyperbaric Medical Center, University Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo, Tokyo, 113-8519, Japan.
Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo, Tokyo, 113-8519, Japan.
J Med Case Rep. 2017 Jan 4;11(1):5. doi: 10.1186/s13256-016-1168-0.
Radiation therapy is performed as an adjuvant therapy when indicated following surgical resection of malignant tumors. However, radiation exposure induces acute or chronic dermatitis, depending on the radiation dose, interval, tissue volume, or irradiated area of the body. Radiation-induced skin ulcers and osteomyelitis of the underlying bone are intractable late-stage complications of radiation therapy, and often require reconstructive surgery to cover exposed tissue. Hyperbaric oxygen therapy has been suggested as a treatment for delayed radiation injury with soft tissue and bony necrosis.
A 74-year-old Japanese female underwent left radical mastectomy for breast cancer (T3N3M0, stage IIIB) in 1987. Radiation therapy was initiated 6 weeks after the surgery. She received telecobalt-60 in a total dose of 50 Gy with 25 fractions to the left supraclavicular, parasternal and left axillary regions, and electron treatment (9 MeV) in a total dose of 50 Gy in 25 fractions to the left chest wall. After irradiation, her skin became thinner and more fragile on the left chest wall, but no severe infections were observed. She noticed a small ulcer that repeatedly healed and recurred in 2000. She visited the hospital where she received radiation therapy and was treated for a skin ulcer on the left chest wall in December 2012. A fistula developed and then pus was discharged in January 2013. She was referred to the hyperbaric medical center in February 2013, and the fistula (1.5 × 3 cm) with pus discharge was observed. She was diagnosed with a late-onset radiation-induced skin ulcer that developed 25 years after radical mastectomy. HBO (2.5 atmospheres absolute with 100% oxygen for 60 minutes) was indicated for the refractory ulcer and osteomyelitis of the ribs. The patient was treated with HBO a total of 101 times over the course of 1 year and completely recovered.
Hyperbaric oxygen therapy can be performed safely for even more than 100 sessions in patients with radiation-induced skin ulcers and osteomyelitis. Hyperbaric oxygen therapy can be considered as an alternative, conservative treatment when surgical resection for late-onset, radiation-induced skin ulcers is not indicated because of fragile skin in the irradiated areas.
放射治疗在恶性肿瘤手术切除后有指征时作为辅助治疗进行。然而，辐射暴露会根据辐射剂量、间隔、组织体积或身体受照射区域诱发急性或慢性皮炎。放射性皮肤溃疡和其下方骨骼的骨髓炎是放射治疗棘手的晚期并发症，通常需要进行重建手术来覆盖暴露的组织。高压氧治疗已被建议作为治疗伴有软组织和骨坏死的延迟性放射损伤的一种方法。
一名74岁的日本女性于1987年因乳腺癌（T3N3M0，IIIB期）接受了左乳根治术。术后6周开始进行放射治疗。她接受了总量为50 Gy、分25次的钴-60远距离照射，照射部位为左锁骨上、胸骨旁和左腋窝区域，以及总量为50 Gy、分25次的9 MeV电子线照射左胸壁。照射后，她左胸壁的皮肤变得更薄更脆弱，但未观察到严重感染。2000年，她注意到一个小溃疡反复愈合和复发。2012年12月，她前往接受放射治疗的医院就诊，接受了左胸壁皮肤溃疡的治疗。2013年1月出现了一个瘘管，随后有脓液排出。2013年2月，她被转诊至高压氧治疗中心，观察到有一个排出脓液的瘘管（1.5×3厘米）。她被诊断为在乳癌根治术后25年出现的迟发性放射性皮肤溃疡。对于难治性溃疡和肋骨骨髓炎，采用高压氧治疗（绝对压力2.5个大气压，100%氧气，持续60分钟）。该患者在1年的时间里共接受了101次高压氧治疗并完全康复。
对于放射性皮肤溃疡和骨髓炎患者，高压氧治疗即使进行100多次也可安全实施。当由于照射区域皮肤脆弱而不适合对迟发性放射性皮肤溃疡进行手术切除时，高压氧治疗可被视为一种替代的保守治疗方法。
