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• W155017870 abstract "Editor—Leach et al discuss various clinical applications of hyperbaric oxygen therapy.1 They conclude that the use of hyperbaric oxygen should be evidence based, but their article omits an important and much researched clinical use—combined radiotherapy and hyperbaric oxygen in patients with cancer.Hyperbaric oxygen was first used 50 years ago to increase cellular oxygen delivery and thus overcome hypoxia as a cause of tumour radioresistance. The Medical Research Council coordinated several large multicentre trials. Significant benefit was found in both locoregional tumour control and survival in head and neck cancer2 and carcinoma of the uterine cervix.3 A meta-analysis of combined hyperbaric oxygen and radiotherapy reviewed 19 trials in tumours at various sites with a total of 2488 patients.4 Locoregional control with the combined modality was 62%, versus 53% with radiotherapy alone (P<0.0001). Subgroup analysis showed that the greatest improvement in local control and survival occurred in head and neck cancer.This scientifically proved application of hyperbaric oxygen is now unused. It was initially hoped that chemical radiosensitisers would substitute for hyperbaric oxygen and so simplify treatment, because animal studies had generated considerable optimism; clinical trials, however, showed only marginal therapeutic gain.Other evidence based developments in radiotherapy have not been implemented. Recent trials of altered radiotherapy fractionation have shown increased local control and survival in some tumours.5 The head and neck hyperfractionation trial of the European Organisation for Research and Treatment of Cancer showed a 19% absolute (47.5% relative) increase in local control and consequent increase in survival. In non-small cell lung cancer a 9% absolute improvement in survival was obtained with continuous hyperfractionated accelerated radiotherapy.These strategies are largely neglected in the United Kingdom because of a lack of radiotherapy resources. The Faculty of Clinical Oncology’s report on radiotherapy in 1992-7 shows large inequalities in service provision, with unacceptable delays before radiotherapy is started. To provide an acceptable minimum of four linear accelerators per million population, capital investment of £50 million a year for five years is required, with commitment to the revenue cost of trained staff. This should be a stated target of the NHS modernisation fund. Radiotherapy is the most important non-surgical modality in the curative treatment of cancer, yet it is underused in the United Kingdom because of a lack of resources. At present, evidence based practice in radiotherapy is unachievable." @default.
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• W155017870 date "1999-04-17" @default.
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• W155017870 title "Hyperbaric oxygen therapy" @default.
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• W155017870 doi "https://doi.org/10.1136/bmj.318.7190.1076c" @default.
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