背景:晚期放射组织损伤是妇科恶性肿瘤患者放疗的严重并发症。管理疼痛和其他临床特征的策略疗效有限;然而,高压氧治疗(HBO(2))可能是一些患者的有效选择。
方法:在对文献的系统回顾中,奥维德medline,Embase,科克伦图书馆,国家准则信息交换所,和加拿大医学协会Infobase数据库被搜索到2009年6月的临床实践指南,系统评价,随机对照试验,或其他相关证据。没有评估软组织坏死的研究,膀胱炎,直肠炎,骨坏死,并排除其他并发症.
结果:两项随机试验,11项非随机研究,证据基础包括五份证明文件。此外,另外3个来源报道了HBO(2)治疗的危害和安全性信息.有适度的直接证据和新出现的间接证据表明,在接受妇科恶性肿瘤治疗的女性中,使用HBO(2)对骨盆的晚期放射性组织损伤具有广泛的有效性。
结论:根据证据和专家共识意见,HBO(2)可能对骨盆的晚期放射性组织损伤有效,对肛门和直肠的辐射损伤具有明确的疗效;妇科肿瘤中HBO(2)治疗的主要适应症是治疗其他难治性慢性辐射损伤;HBO(2)可能在某些临床环境中提供对症益处(例如,膀胱炎,软组织坏死,和骨坏死);HBO(2)可以减少接受手术切除坏死的患者的妇科手术并发症。
BACKGROUND: Late radiation tissue injury is a serious complication of radiotherapy for patients with gynecologic malignancies. Strategies for managing pain and other clinical features have limited efficacy; however, hyperbaric oxygen therapy (HBO(2)) may be an effective option for some patients.
METHODS: In a systematic review of the literature, the Ovid medline, embase, Cochrane Library, National Guidelines Clearinghouse, and Canadian Medical Association Infobase databases were searched to June 2009 for clinical practice guidelines, systematic reviews, randomized controlled trials, or other relevant evidence. Studies that did not evaluate soft tissue necrosis, cystitis, proctitis, bone necrosis, and other complications were excluded.
RESULTS: Two randomized trials, eleven nonrandomized studies, and five supporting documents comprise the evidence base. In addition, information on the harms and safety of treatment with HBO(2) were reported in three additional sources. There is modest direct evidence and emerging indirect evidence that the use of HBO(2) is broadly effective for late radiation tissue injury of the pelvis in women treated for gynecologic malignancies.
CONCLUSIONS: Based on the evidence and expert consensus opinion, HBO(2) is likely effective for late radiation tissue injury of the pelvis, with demonstrated efficacy specifically for radiation damage to the anus and rectum;the main indication for HBO(2) therapy in gynecologic oncology is in the management of otherwise refractory chronic radiation injury;HBO(2) may provide symptomatic benefit in certain clinical settings (for example, cystitis, soft-tissue necrosis, and osteonecrosis); andHBO(2) may reduce the complications of gynecologic surgery in patients undergoing surgical removal of necrosis.