Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Dr Eva Meier, Department of Plastic and Reconstructive Surgery (hp 634), Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands,
Diving Hyperb Med. 2021 Sep 30;51(3):288-294. doi: 10.28920/dhm51.3.288-294.
Radiotherapy reduces the risk of locoregional recurrence of breast cancer. As a side-effect, tissue can become hypocellular, hypovascular, and hypoxic and late radiation tissue injury can develop months or years later. Radiotherapy increases the risk of complications following secondary breast reconstruction. Hyperbaric oxygen treatment (HBOT) improves oxygenation of irradiated tissue and induces neovascularisation. This study evaluated whether the incidence of complications following secondary breast reconstruction after radiotherapy is decreased with perioperative HBOT.
In this retrospective case-control chart review study, patients who underwent perioperative HBOT (n = 15) were compared to lifestyle-matched (n = 15) and radiation damage-matched (n = 15) patients who underwent secondary breast reconstruction without HBOT.
The HBOT group had significantly more severe radiation damage of the breast than the lifestyle- and radiation-damage-matched control groups (scoring grade 1-4, mean 3.55 versus 1.75 and 2.89 respectively, P = 0.001). Patients underwent on average 33 sessions of HBOT (18 sessions preoperatively and 15 sessions postoperatively). There was no significant difference in the incidence of postoperative complications between the HBOT group, lifestyle-matched group and radiation damage-matched group. Logistic regression analysis showed a lower risk of postoperative complications in patients who underwent HBOT.
Although the HBOT group had more radiation damage than the control groups, the incidence of postoperative complications was not significantly different. This implied a beneficial effect of HBOT, which was supported by the logistic regression analysis. Definitive conclusions cannot be drawn due to the small sample size. Future research is justified, preferably a large randomised controlled trial.
放射治疗可降低乳腺癌局部复发的风险。作为副作用，组织会变得细胞数量减少、血管减少且缺氧，并且在数月或数年后可能会发展为迟发性放射组织损伤。放射治疗会增加乳房重建后发生并发症的风险。高压氧治疗（HBOT）可改善照射组织的氧合作用并诱导新生血管形成。本研究评估了在放射治疗后进行乳房重建时，围手术期接受 HBOT 是否会降低并发症的发生率。
在这项回顾性病例对照图表审查研究中，将接受围手术期 HBOT（n = 15）的患者与接受生活方式匹配（n = 15）和放射损伤匹配（n = 15）的患者进行比较，后者未接受 HBOT 治疗，进行了乳房重建。
HBOT 组的乳房放射损伤程度明显高于生活方式和放射损伤匹配的对照组（评分 1-4 级，平均值分别为 3.55、1.75 和 2.89，P = 0.001）。患者平均接受 33 次 HBOT（术前 18 次，术后 15 次）。HBOT 组、生活方式匹配组和放射损伤匹配组之间的术后并发症发生率无显著差异。Logistic 回归分析显示，接受 HBOT 的患者术后发生并发症的风险较低。
尽管 HBOT 组的放射损伤程度高于对照组，但术后并发症的发生率无显著差异。这意味着 HBOT 具有有益的效果，这一结果得到了逻辑回归分析的支持。由于样本量较小，无法得出明确的结论。有理由进行进一步的研究，最好是进行大规模的随机对照试验。
