Alpuim Costa Diogo, Sampaio-Alves Mafalda, Netto Eduardo, Fernandez Gonçalo, Oliveira Edson, Teixeira Andreia, Daniel Pedro Modas, Bernardo Guilherme Silva, Amaro Carla
Haematology and Oncology Department, CUF Oncologia, Lisbon, Portugal.
NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Lisbon, Portugal.
Front Neurol. 2022 Jul 1;13:886603. doi: 10.3389/fneur.2022.886603. eCollection 2022.
Glioblastoma (GBM) is the most common and aggressive malignant brain tumor in adults. The mainstay of management for GBM is surgical resection, radiation (RT), and chemotherapy (CT). Even with optimized multimodal treatment, GBM has a high recurrence and poor survival rates ranging from 12 to 24 months in most patients. Recently, relevant advances in understanding GBM pathophysiology have opened new avenues for therapies for recurrent and newly diagnosed diseases. GBM's hypoxic microenvironment has been shown to be highly associated with aggressive biology and resistance to RT and CT. Hyperbaric oxygen therapy (HBOT) may increase anticancer therapy sensitivity by increasing oxygen tension within the hypoxic regions of the neoplastic tissue. Previous data have investigated HBOT in combination with cytostatic compounds, with an improvement of neoplastic tissue oxygenation, inhibition of HIF-1α activity, and a significant reduction in the proliferation of GBM cells. The biological effect of ionizing radiation has been reported to be higher when it is delivered under well-oxygenated rather than anoxic conditions. Several hypoxia-targeting strategies reported that HBOT showed the most significant effect that could potentially improve RT outcomes, with higher response rates and survival and no serious adverse events. However, further prospective and randomized studies are necessary to validate HBOT's effectiveness in the 'real world' GBM clinical practice.
胶质母细胞瘤（GBM）是成人中最常见且侵袭性最强的恶性脑肿瘤。GBM的主要治疗方法是手术切除、放疗（RT）和化疗（CT）。即使采用优化的多模式治疗，GBM的复发率仍很高，大多数患者的生存率较差，生存期在12至24个月之间。最近，在理解GBM病理生理学方面的相关进展为复发性和新诊断疾病的治疗开辟了新途径。GBM的缺氧微环境已被证明与侵袭性生物学行为以及对放疗和化疗的耐药性高度相关。高压氧治疗（HBOT）可能通过增加肿瘤组织缺氧区域的氧张力来提高抗癌治疗的敏感性。先前的数据研究了HBOT与细胞抑制化合物联合使用的情况，结果显示肿瘤组织氧合改善、HIF-1α活性受到抑制，GBM细胞的增殖显著减少。据报道，在充分氧合而非缺氧条件下进行电离辐射时，其生物学效应更高。一些针对缺氧的策略报告称，HBOT显示出最显著的效果，有可能改善放疗效果，提高缓解率和生存率，且无严重不良事件。然而，需要进一步的前瞻性和随机研究来验证HBOT在“现实世界”GBM临床实践中的有效性。
