Hyperbaric oxygen therapy for late radiation tissue toxicity injury after head and neck cancer: a systematic review of the literature

Background: Head and neck cancer (HNC), most of which are squamous cell carcinomas, is the seventh most common cancer worldwide. Radiotherapy is a standard treatment for HNC but may lead to late complications and severe complications like osteoradionecrosis (ORN) and impaired wound healing due to tissue hypoxia. Hyperbaric oxygen therapy (HBOT) has shown promise in ameliorating these late radiation effects. The purpose of this review is to summarize the extent of the literature on the effectiveness of HBOT in the treatment of late radiation tissue toxicity injuries (LRTTI) specifically in HNC patients. Methods/material and methods: A systematic literature search was performed using PubMed, Embase, and the Cochrane Library on August 12, 2024, including studies published between 2004 and 2022. Studies that included HNC patients with LRTTI and treated with HBOT were selected. Articles were critically appraised using the Joanna Briggs Institute (JBI) checklists. Data on patient characteristics, HBOT treatment details, and main outcomes were extracted. Primary outcomes assessed included clinical changes, such as the Notani score, while secondary outcomes focused on patient-reported measures such as VAS and OHIP. Descriptive analysis, supported by statistical measures, was used to interpret the results. Results: A total of 17 studies were reviewed, including 640 HNC patients with LRTTI who were treated with HBOT. In this systematic review, HBOT is presented in the included studies as a reliable and safe treatment for the treatment of LRTTI in HNC patients, with positive outcomes observed in 14 out of 17 studies. Specifically, almost all studies investigating ORN and oral health reported beneficial effects, with significant p-values in multiple cases. Overall, significant p-values were found in 11 studies, with a low incidence of adverse effects reported across the studies. Conclusion: This review suggests that HBOT may be effective in the treatment of LRTTI in HNC patients. However, the supporting evidence is mainly derived from low quality studies with a high risk of bias, limited sample sizes, and inconsistent outcome measures. Additional high quality studies are needed to clarify the true clinical benefits and optimal use of HBOT.