Hyperbaric Chamber as Complementary Treatment to Standard Therapy for Brain Tumors: beneficial or not?

Câmara Hiperbárica como Tratamento Complementar à Terapia Padrão para Tumores Cerebrais: há benefícios?

• Mateus Gonçalves de Sena Barbosa 1    
• Luiz Gabriel Gonçalves Cherain 1
• Sthefanny Rodrigues de Souza 1
• Renato de Almeida Porto 1
• Omar Virginio Badauy Filho 1
• Maria Fernanda Gonçalves Araújo 1
• Maria Laura Oliveira Lima 1
• Nícollas Nunes Rabelo 2    
• Josué da Silva Brito 3    

• https://doi.org/10.22290/jbnc.2024.350204
• J Bras Neurocirur 35 (2):68-75, 2024

Resumo

 Introdução: A oxigenoterapia hiperbárica é uma intervenção terapêutica que consiste em expor o paciente a concentrações puras de oxigênio (O2) a uma pressão atmosférica aumentada. Objetivo: O presente estudo tem como objetivo investigar se o uso da oxigenoterapia por meio da câmara hiperbárica aumenta a eficácia do tratamento padrão de tumores cerebrais quando comparado à ausência de terapia, fornecendo referências para intervenções voltadas a esses tumores. Métodos: Foi realizada uma busca nas bases de dados PubMed, Medline, SciELO, Cochrane e Web of Science com os termos “hyperbaric oxygenation”, “hyperbaric oxygen therapy”, “brain cancer”, “brain tumor”, “glioma” com o auxílio dos operadores booleanos OR (OR) e AND (AND). Selecionamos 22 artigos em português, inglês e espanhol que se relacionavam mais adequadamente com os objetivos deste trabalho, usando os critérios PRISMA. Resultados: Foram expostas análises sobre a oxigenoterapia hiperbárica adjunta no tratamento de tumores cerebrais, apontando benefícios clínicos e riscos raros, incluindo convulsões tônico-clônicas generalizadas devido à toxicidade do oxigênio no SNC. Conclusão: A câmara hiperbárica é significativamente útil no tratamento adjuvante de tumores cerebrais, com remissão do tumor. Entretanto, seu uso em pacientes pediátricos de neuro-oncologia com PIC elevada deve ser revisto, enfatizando a necessidade de maior cautela na recomendação do uso.

Palavras-chave

Tumor cerebral; Glioma; Oxigenoterapia hiperbárica

Abstract

Introduction: Hyperbaric oxygen therapy (HBO) is a therapeutic intervention that consists of exposing the patient to pure concentrations of oxygen (O2) at increased atmospheric pressure. Objective: The present study aims to investigate whether the use of oxygen therapy through the hyperbaric chamber increases the effectiveness of the standard treatment of brain tumors when compared to no therapy, providing references for interventions aimed at these tumors. Methods: A search was carried out in PubMed, Medline, SciELO, Cochrane and Web of Science databases using these terms “hyperbaric oxygenation”, “hyperbaric oxygen therapy”, “brain cancer”, “brain tumor”, “glioma” with the aid of the Boolean operators OR (OR) and AND (AND). The most adequately related to the objectives of this work resulted in 22 articles in Portuguese, English and Spanish, using the PRISMA criteria. Results: Analysis on adjunctive hyperbaric oxygen therapy (HBO) in the treatment of brain tumors has been made, pointing out clinical benefits and rare risk including generalized tonic-clonic seizures due to CNS oxygen toxicity. Conclusion: The hyperbaric chamber is significantly useful in the adjunctive treatment of brain tumors, with tumor remission. However, its use in pediatric neuro-oncology patients with elevated ICP should be reviewed, emphasizing the need for greater caution in recommending use.

Keywords

Brain tumor; Glioma; Hyperbaric Oxygen Therapy

References

 1. Moon RE. Hyperbaric oxygen therapy indications. North Palm Beach: Undersea and Hyperbaric Medical Society; 2019. 406 p.

2. Undersea and Hyperbaric Medical Society. UHMS position statement: low-pressure fabric hyperbaric chambers title: low-pressure fabric hyperbaric chambers. Undersea Hyperb Med. 2018;45(4):486-7. http://doi.org/10.22462/07.08.2018.15. PMid:30241130.

3. Jones MW, Brett K, Han N, Wyatt HA. Hyperbaric physics. Treasure Island: StatPearls Publishing; 2021. Available from: https://www.ncbi. nlm.nih.gov/books/NBK448104/. Accessed: 4/10/2022.

4. Ortega MA, Fraile-Martinez O, Garcia-Montero C, et al. A general overview on the hyperbaric oxygen therapy: applications, mechanisms and translational opportunities. Medicina. 2021;57(9):864. http://doi. org/10.3390/medicina57090864. PMid:34577787.

5. Hou S, Wu G, Liang J, Cheng H, Chen C. Hyperbaric oxygen on rehabilitation of brain tumors after surgery and effects on TNF-α and IL-6 levels. Oncol Lett. 2019;17(3):3277-82. http://doi.org/10.3892/ ol.2019.10000. PMid:30867760.

6. Stępień K, Ostrowski RP, Matyja E. Hyperbaric oxygen as an adjunctive therapy in treatment of malignancies, including brain tumours. Med Oncol. 2016;33(9):101. http://doi.org/10.1007/s12032- 016-0814-0. PMid:27485098.

7. Pangal DJ, Baertsch H, Kellman EM, et al. Complementary and alternative medicine for the treatment of gliomas: scoping review of clinical studies, patient outcomes, and toxicity profiles. World Neurosurg. 2021;151:e682-92. http://doi.org/10.1016/j.wneu.2021.04.096. PMid:33940275.

8. Li B, Cao D-M, Xue T, Ding J-S, Chen G. A narrative review of adjuvant therapy for glioma: hyperbaric oxygen therapy. Med Gas Res. 2021;11(4):155-7. http://doi.org/10.4103/2045-9912.318861. PMid:34213498.

9. Webster J, Watson RT. Analyzing the past to prepare for the future: writing a literature review. Manage Inf Syst Q. 2002;26(2):13-23.

10. Gil AC. Methods and techniques of social research. 6th ed. São Paulo: Atlas SA; 2008.

11. Rodrigues TDFF, Oliveira GS, Santos JA. As pesquisas qualitativas e quantitativas na educação. Prisma. 2021;2(1):154-74.

12. Pizzani L, Silva RC, Bello SF, Hayashi MCPI. A arte da pesquisa bibliográfica na busca do conhecimento. Rev Digit Bibliotecon Cienc Inf. 2012;10(2):53-66. http://doi.org/10.20396/rdbci.v10i1.1896.

13. Chen JR, Xu HZ, Ding JB, Qin ZY. Radiotherapy after hyperbaric oxygenation in malignant gliomas. Curr Med Res Opin. 2015;31(11):1977- 84. http://doi.org/10.1185/03007995.2015.1082988. PMid:26414129.

14. Augur ZM, Doyle CM, Li M, Mukherjee P, Seyfried TN. Nontoxic targeting of energy metabolism in preclinical VM-M3 experimental glioblastoma. Front Nutr. 2018;5:91. http://doi.org/10.3389/ fnut.2018.00091. PMid:30349820.

15. Kohshi K, Yokota A, Konda N, Kinoshita Y, Kajiwara H. Intracranial pressure responses during hyperbaric oxygen therapy. Neurol Med Chir. 1991;31(9):575-81. http://doi.org/10.2176/nmc.31.575. PMid:1723171.

16. Suzuki Y, Tanaka K, Negishi D, et al. Pharmacokinetic investigation of increased efficacy against malignant gliomas of carboplatin combined with hyperbaric oxygenation. Neurol Med Chir. 2009;49(5):193-7. http://doi.org/10.2176/nmc.49.193. PMid:19465788.

17. Aghajan Y, Grover I, Gorsi H, Tumblin M, Crawford JR. Use of hyperbaric oxygen therapy in pediatric neuro-oncology: a single institutional experience. J Neurooncol. 2019;141(1):151-8. http://doi. org/10.1007/s11060-018-03021-x. PMid:30426388.

18. Yahara K, Ohguri T, Udono H, et al. Radiotherapy using IMRT boosts after hyperbaric oxygen therapy with chemotherapy for glioblastoma. J Radiat Res. 2017;58(3):351-6. http://doi.org/10.1093/jrr/rrw105. PMid:27864508.

19. Chuba PJ, Aronin P, Bhambhani K, et al. Hyperbaric oxygen therapy for radiation-induced brain injury in children. Cancer. 1997;80(10):2005- 12. http://doi.org/10.1002/(SICI)1097-0142(19971115)80:10<2005::AID-CNCR19>3.0.CO;2-0. PMid:9366305.

20. Beppu T, Kamada K, Nakamura R, et al. A phase II study of radiotherapy after hyperbaric oxygenation combined with interferon-beta and nimustine hydrochloride to treat supratentorial malignant gliomas. J Neurooncol. 2003;61(2):161-70. http://doi. org/10.1023/A:1022169107872. PMid:12622455.

21. Kohshi K, Kinoshita Y, Imada H, et al. Effects of radiotherapy after hyperbaric oxygenation on malignant gliomas. Br J Cancer. 1999;80(1- 2):236-41. http://doi.org/10.1038/sj.bjc.6690345. PMid:10390002. 22. Dowling S, Fischer JJ, Rockwell S. Fluosol and hyperbaric oxygen as an adjunct to radiation therapy in the treatment of malignant gliomas: a pilot study. Biomater Artif Cells Immobilization Biotechnol. 1992;20(2- 4):903-5. http://doi.org/10.3109/10731199209119738. PMid:1327243.

23. Ogawa K, Ishiuchi S, Inoue O, et al. Phase II trial of radiotherapy after hyperbaric oxygenation with multiagent chemotherapy (procarbazine, nimustine, and vincristine) for high-grade gliomas: long-term results. Int J Radiat Oncol Biol Phys. 2012;82(2):732-8. http://doi.org/10.1016/j. ijrobp.2010.12.070. PMid:21420247.

24. Doherty MJ, Hampson NB. Partial seizure provoked by hyperbaric oxygen therapy: possible mechanisms and implications. Epilepsia. 2005;46(6):974-6. http://doi.org/10.1111/j.1528-1167.2005.69804.x. PMid:15946345.

25. Kohshi K, Yamamoto H, Nakahara A, Katoh T, Takagi M. Fractionated stereotactic radiotherapy using gamma unit after hyperbaric oxygenation on recurrent high-grade gliomas. J Neurooncol. 2007;82(3):297-303. http://doi.org/10.1007/s11060-006-9283-1. PMid:17120158.

26. Ogawa K, Yoshii Y, Inoue O, et al. Phase II trial of radiotherapy after hyperbaric oxygenation with chemotherapy for high-grade gliomas. Br J Cancer. 2006;95(7):862-8. http://doi.org/10.1038/sj.bjc.6603342. PMid:16953239.

27. Beppu T, Kamada K, Yoshida Y, Arai H, Ogasawara K, Ogawa A. Change of oxygen pressure in glioblastoma tissue under various conditions. J Neurooncol. 2002;58(1):47-52. http://doi. org/10.1023/A:1015832726054. PMid:12160140.

---

1MS, Medical student, Faculdade Medicina, UniAtenas, Passos, MG, Brazil.

2MD, PhD, Neurosurgeon, Neurosurgery Department, Faculdade Medicina, UniAtenas, Passos, MG, Brazil.

3MD, Faculdade Medicina, UniAtenas, Passos, MG, Brazil.

 

Received July 23, 2023

Accepted Aug 15, 2023