[abstract] EFFECTIVENESS OF HYPERBARIC OXYGEN THERAPY FOR THE TREATMENT OF RADIOSURGERY-INDUCED BRAIN NECROSIS

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[abstract] EFFECTIVENESS OF HYPERBARIC OXYGEN THERAPY FOR THE TREATMENT OF RADIOSURGERY-INDUCED BRAIN NECROSIS

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Title: [abstract] EFFECTIVENESS OF HYPERBARIC OXYGEN THERAPY FOR THE TREATMENT OF RADIOSURGERY-INDUCED BRAIN NECROSIS
Author: Gesell, LB; Warnick, RE; Breneman, J; Albright, R
Abstract: INTRODUCTION: Hyperbaric oxygen therapy (HBOT) is routinely used to treat radiation injury. It may reduce brain radionecrosis by virtue of its ability to decrease tissue edema and induce angiogenesis. We report preliminary results of HBOT for treatment of progressive brain necrosis occurring after stereotactic radiosurgery. METHODS: Twelve patients developed clinical and radiographic evidence of necrosis after radiosurgical treatment of tumor (6-gliomas, 4-metastases, 1-meningioma) or vascular malformation (1-AVM). Radionecrosis was diagnosed by PET/SPECT imaging or biopsy in tumor patients. Individuals received 20-60 HBOT at 2.5 ATA for 90 min and were followed utilizing neurological examination and MRI. RESULTS: Mean radiosurgery dose: 1800 cGy (1400-2200). Average time to necrosis: 7 months (2-24). All patients had progressive focal neurological deficits (KPS 40-90), increasing steroid requirements (mean dexamethasone 16mg/day), and MRI demonstrating an expanding ring-enhancing mass with extensive surrounding edema. Eight patients (4-metastases, 2-gliomas, 1-meningioma, 1-AVM) sustained clinical and radiographic improvement (follow-up 3-30+ months, mean 11 months). Two patients (2-gliomas) had stabilization of symptoms and MRI scans for an average of 6 months before experiencing progressive necrosis leading to death (1 patient) or surgery (1 patient). Two patients (2-gliomas) exhibited gradual deterioration during HBOT leading to death (1 patient) or surgery (1 patient). MRI scans of responders showed an initial decrease in perilesional edema followed by reduction in volume of contrast enhancement. Benefit of HBOT was most obvious in two patients with benign pathologies (meningioma, AVM) who are alive and well at greater than 2.5 years after HBOT. CONCLUSIONS: Our initial experience supports that HBOT is an effective treatment for patients who develop brain radiation necrosis after radiosurgery. HBOT may obviate the need for surgery in patients with progressive symptoms and mass effect. As we gain more experience with this treatment modality, we hope to identify factors (e.g., lesion volume) that would predict response to HBOT.
Description: Undersea and Hyperbaric Medical Society, Inc. (http://www.uhms.org )
URI: http://archive.rubicon-foundation.org/943
Date: 2001

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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