Cancer Therapy
Hyperbaric oxygen therapy ( HBOT)
What is hyperbaric oxygen therapy?
Hyperbaric oxygen therapy involves placing the patient in a completely sealed pressure chamber and inhaling pure oxygen at a pressure higher than normal (above 1.3 atmospheres absolute). The main purpose of hyperbaric oxygen therapy is to increase blood oxygen concentration, promote oxygen dissolution in the blood, and increase tissue oxygen content, thereby accelerating the body's self-repair and enhancing tissue oxygenation. It also utilizes physical principles to increase the oxygen dissolved in blood plasma.
As of July 2021, the FDA has approved 13 indications for the use of hyperbaric oxygen therapy, including the treatment of hearing loss (sudden onset of complete hearing loss without any known cause); and the Undersea and Hyperbaric Medical Society (UHMS) also included sudden sensorineural hearing loss in its approved indications in 2011.
Precautions for hyperbaric oxygen therapy
Hyperbaric oxygen therapy has many benefits for the body's repair process. However, if you need to undergo hyperbaric oxygen therapy, please note the following:
Treatment environment
Treatment should be performed in a professional hyperbaric oxygen chamber, and the equipment should be safety certified to ensure environmental safety and compliance with relevant standards.
Medical assessment
A comprehensive evaluation must be conducted before receiving hyperbaric oxygen therapy to understand the patient's medical history and current health status.
Follow medical guidance
Strictly follow the doctor's advice and plan for treatment, and avoid adjusting the course or frequency of treatment on your own.
The relationship between oxygen and the body
The human body is made up of billions of cells, and each cell needs to take in enough oxygen to produce energy, promote growth, repair and improve cell function in order to maintain bodily functions.
The body delivers oxygen throughout the body via the bloodstream, helping to fight bacteria and stimulating the release of growth factors and stem cells for repair. When the body has a sufficient supply of oxygen, damaged tissues can regenerate, the immune system is strengthened, and the healing process is accelerated.
When in a normal atmospheric environment, at one standard atmosphere (ATA), the air we inhale is only about 21% oxygen. The body consumes oxygen during metabolism. When the body lacks sufficient oxygen, cells may experience hypoxia, producing free radicals and leading to gradual aging. As we age, human cells and tissues begin to be damaged, requiring oxygen to initiate cell repair and healing.
During hyperbaric oxygen therapy, the pressure chamber is increased to 1.3–2.4 ATA. When breathing pure oxygen in a high-pressure environment, the oxygen in the blood plasma increases the oxygen content in the tissues, improving tissue hypoxia, promoting tissue proliferation and wound healing, enhancing the bactericidal ability of white blood cells, and eliminating harmful gases, thereby achieving the therapeutic goal.
Standard treatment plan
-Treatment pressure: usually 2.0-2.5ATA
–Treatment time: 90-120 minutes each time (including pressurization and decompression time)
–Frequency of treatment: acute diseases may be 1-3 times a day, chronic diseases usually 1 time a day
–Length of treatment: Depending on the condition, 5-60 treatments may be required
▲Which patients are suitable for routine indications of hyperbaric oxygen therapy?
Conventional indications approved by the Hong Kong Department of Health include：
1. *Emergency indications*：
–Decompression sickness (diver's disease)
–Arterial gas embolism
–Carbon monoxide poisoning and smoke inhalation
–Necrotizing soft tissue infection
-Acute traumatic ischemia (such as squeeze injury, fascia ventricular syndrome)
– Ischemic stroke / Cerebral stroke
2. *Chronic diseases*：
–Diabetic foot ulcer
-Radioactive tissue damage (such as radioactive osteonecrosis, radioactive cystitis/proctitis)
–Difficult to heal wounds
-Chronic osteomyelitis
–Sudden deafness
▲Application of hyperbaric oxygen therapy in oncology
Management of complications after radiotherapy:
Osteoradionecrosis
-Mechanism: HBOT promotes angiogenesis and fibroblast activation by increasing tissue oxygenation
– Hong Kong clinical practice: The commonly used regimen is 2.4 ATA, 90 minutes per session, 30-40 treatments.
– Research from the University of Hong Kong shows that combined with surgical debridement, the effectiveness rate reaches 75-85%
– Particularly suitable for radiation-induced osteonecrosis of the mandible.
Radiation-induced cystitis/proctitis
-Therapeutic effect: reduce hematuria and pain symptoms, promote mucosal repair
–The Prince of Wales Hospital report shows that 60% of patients have significantly improved their symptoms
Soft tissue radiation necrosis
–Suitable for radioactive damage to the breasts, head and neck and other areas
–Need to be combined with wound care and antibiotics
The relationship between hyperbaric oxygen and tumor biology
Effects of tumor hypoxia:
-Upregulation of hypoxia inducing factor (HIF-1a) promotes tumor invasion and metastasis
– Cause resistance to radiation therapy and certain chemotherapy drugs
Potential effects of HBOT on tumors：
–May promote tumor growth (by improving tumor microenvironment oxygenation)
–Active malignant tumors are not absolute contraindications, but need to be evaluated on a case-by-case basis
–When it is recommended for the treatment of radioactive damage, it is necessary to confirm the presence of an inactive tumor
▲Application of hyperbaric oxygen therapy in cancer supportive care
Improve chemotherapy-related side effects：
–Treatment of tissue damage caused by certain chemotherapy drugs (such as pleomycin pulmonary toxicity)
–Hong Kong oncology doctors report that it can reduce the symptoms of peripheral neuropathy
Postoperative wound healing：
–Especially suitable for postoperative surgery in areas that have received radiation therapy
–Can reduce the risk of flap necrosis
Improved quality of life:
-Relieve cancer-related fatigue (small-scale studies have shown potential benefits)
–Improve cognitive function (for chemotherapy brain phenomenon)
Special considerations for hyperbaric oxygen therapy in Hong Kong
Positioning in the medical system：
–Public hospitals: mainly deal with emergencies and radioactive injuries
–Private institutions: provide a wider range of indications, including adjuvant cancer treatment
Expenses and insurance coverage：
–Public hospitals: patients who meet the indications can receive government subsidies
– Private institutions: approximately HKD2,000-5,000 per treatment
–Some high-end medical insurance plans cover specific indications
Safety specification：
Hyperbaric oxygen therapy in Hong Kong strictly follows international standards：
-Safety guidelines issued by the Hong Kong Department of Health
–Regular equipment inspection and maintenance
–Medical staff need to complete international certification training
Research and innovation：
Ongoing research in major medical centers in Hong Kong：
–The effect of HBOT on the quality of life after radiation for head and neck cancer (The Chinese University of Hong Kong)
–Evaluation of the efficacy of new treatment options on radioactive enteritis (University of Hong Kong)
-Exploration of the synergy between HBOT and immunotherapy (Private research institute)
▲ Sharing of clinical cases of hyperbaric oxygen therapy in Hong Kong
Case 1: Nasopharyngeal Carcinoma Radiation-Induced Osteonecrosis of the Mandible
-Background: 58-year-old male, jaw pain and closed teeth 3 years after radiotherapy for nasopharyngeal cancer
–HBOT plan: 2.4 ATA, 1 time a day, a total of 40 times
–Results: The pain score decreased from 8/10 to 2/10, and the opening of the mouth improved by 50%
Case 2: Post-radiation chest wall ulceration following breast cancer
-Background: 45-year-old woman, radiotherapy after mastectomy, non-healing ulcer after 18 months
-Comprehensive treatment: HBOT with negative pressure wound treatment
–Result: The wound healed completely after 12 weeks
Future development direction
Precision medical applications：
-Personalized HBOT program guided by biomarkers
-Imaging monitoring of treatment response (such as PET-CT to assess the improvement of tumor hypoxia)
Combination therapy strategy：
-Potential synergy with immune checkpoint inhibitors
–Research on timing and application to enhance the effectiveness of chemotherapy drugs
Technical improvement：
–Development of portable hyperbaric oxygen equipment
-Intelligent treatment monitoring system
In Hong Kong, hyperbaric oxygen therapy (HBOT) is primarily used in oncology as an effective tool for managing radiation damage, with well-established clinical guidelines and extensive treatment experience. While further research is needed on its direct anti-tumor applications, it has already established a significant role in improving the quality of life for cancer patients and treating related complications. With the development of personalized medicine, HBOT's role in comprehensive cancer treatment will be further expanded.
Immunotherapy is typically administered intravenously, with the specific treatment time and duration depending on the individual patient's condition. Administration is usually every 2 to 3 weeks, with each session lasting approximately 30 to 90 minutes. In Hong Kong, doctors closely monitor the patient's condition to adjust the dosage, ensuring the safety and effectiveness of the treatment.
Hyperbaric Oxygen therapy Regimen-Sudden deafness
Hyperbaric Oxygen Therapy Program – Sudden Hearing Loss
Sudden deafness (commonly known as ear stroke) is a disease in which hearing is suddenly reduced; patients experience symptoms such as hearing loss on one side, tinnitus, a feeling of fullness in the ear, and even dizziness after waking up.
Definition of sudden hearing loss
According to the American Academy of Otolaryngology, sudden hearing loss is defined as a sensorineural hearing loss exceeding 30 decibels at three consecutive sound frequencies within three days, which may be accompanied by symptoms such as tinnitus, ear fullness, headache, and dizziness. In the United States, there are 5 to 20 cases per 100,000 people annually, with a roughly equal male-to-female ratio, primarily affecting people aged 40-60. It usually occurs in only one ear, and it is rare for both ears to be affected simultaneously.
Causes of sudden deafness
There are many possible causes of sudden deafness. The cause of this disease is unknown. It can be a single disease. More than 100 causes of this disease have been recorded in the literature. Currently, the cause can be found in only about 5-10% of cases in clinical practice.
Since human inner ear tissue is unavailable, the pathophysiology of the inner ear in these patients is difficult to study. Currently, the main hypotheses for the possible causes of sudden deafness are as follows:
1. Viral infections: such as acute vestibular neuritis, diffuse labyrinthitis (inner otitis), influenza, enterovirus, mumps, measles, etc. In the past, some scholars speculated that sudden deafness might be related to mumps virus or varicella-zoster virus. Other literature reports a possible link to recent infections with influenza virus, Epstein-Barr virus (EBV), herpes simplex virus, cytomegalovirus, etc. Furthermore, the recent increase in the number of patients with sudden deafness following SARS-CoV-2 infection, with MRI scans showing inflammation of the inner ear, has also contributed to this.
2. Blood and vascular problems: These include vasospasm (inner ear blood vessels), stroke, thrombosis, and vasculitis. Since the human cochlea is supplied by a tiny terminal blood flow, microcirculatory disturbances in the inner ear (including atherosclerosis, thrombosis, and vasospasm) have been proposed as a possible cause of sudden deafness. One analysis report indicates that patients with sudden deafness have a relative risk of developing a stroke approximately 1.42 times higher, while there is no significant association with subsequent myocardial infarction.
3. Systemic and immune diseases: such as poorly controlled diabetes, thyroid dysfunction, systemic autoimmune diseases, and kidney disease. Some autoimmune diseases can also manifest as sensorineural hearing loss, such as rheumatoid arthritis, systemic lupus erythematosus, Wegener's granulomatosis, polyarteritis nodosa, and Bethel's disease.
4. Sudden and drastic changes in the body: such as after long-term strenuous work and significant mental stress, after undergoing major surgery, or after long-term travel.
5. Tumor formation: such as acoustic neuroma, skull base tumors compressing the internal auditory canal; neuroma or tumors between the cerebellum and pons, etc.
6. Perilymphatic fluid leakage and fistula: such as head or ear injuries, car accidents, flying, diving, etc.
Treatment for sudden hearing loss
Traditional treatment, in addition to oral and injectable prednisolone during hospitalization, may also include hyperbaric oxygen therapy.
The principle is:
Increasing the partial pressure of oxygen increases the amount of dissolved oxygen in the plasma and the oxygen diffusion rate. Therefore, it can rapidly correct tissue hypoxia. Furthermore, the greater the partial pressure difference of gases, the faster the diffusion rate. Therefore, the more hypoxic a site is, the more oxygen will diffuse to that site under hyperbaric oxygen pressure.
It can reduce hematocrit, blood viscosity and increase red blood cell elasticity, thereby improving microcirculation and also greatly helping to improve tissue blood perfusion and hypoxia.
Anti-inflammatory effects: Hyperbaric oxygen has immunomodulatory and anti-inflammatory effects, thereby reducing tissue damage caused by inflammation.
When oxygen partial pressure increases, heart rate slows down, cerebral blood vessels constrict, arterial blood pressure decreases, and cerebral blood flow can decrease by 21%. However, due to the increased blood oxygen content, tissue oxygenation still increases, while vasoconstriction can improve or prevent edema, exudation, and hemorrhage in the inner ear tissues.
What is hyperbaric oxygen therapy?
Hyperbaric oxygen therapy involves placing the patient in a completely sealed pressure chamber and inhaling pure oxygen at a pressure higher than normal (above 1.3 atmospheres absolute). The main purpose of hyperbaric oxygen therapy is to increase blood oxygen concentration, promote oxygen dissolution in the blood, and increase tissue oxygen content, thereby accelerating the body's self-repair and enhancing tissue oxygenation. It also utilizes physical principles to increase the oxygen dissolved in blood plasma.
As of July 2021, the FDA has approved 13 indications for the use of hyperbaric oxygen therapy, including the treatment of hearing loss (sudden onset of complete hearing loss without any known cause); and the Undersea and Hyperbaric Medical Society (UHMS) also included sudden sensorineural hearing loss in its approved indications in 2011.
There are numerous studies and discussions on the evidence-based medical evidencefor the use of hyperbaric oxygen therapy in the treatment of sudden hearing loss .
In Jain's textbook on hyperbaric oxygen therapy (4th ed., 2004), many comparisons between control groups and hyperbaric oxygen groups are listed. These studies all indicate that adding hyperbaric oxygen therapy as an adjunct to traditional treatment can increase the effectiveness of treatment for sudden deafness.
In the Cochrane Evidence-Based Medicine database, Bennet et al.'s analysis showed that adjunctive hyperbaric oxygen therapy helps improve hearing in patients with sudden deafness. A small, prospective, randomized clinical study by Topuz et al. (2004) found that the hearing recovery in the hyperbaric oxygen therapy group (hyperbaric oxygen + conventional treatment) was significantly better than that in the control group (conventional treatment only). Furthermore, hyperbaric oxygen therapy significantly improved hearing in patients with sudden moderate to severe hearing loss (mean pure-tone audiometry greater than 60 dB). Aslan et al. and Topuz et al. also found that patients under 50 years of age responded better to hyperbaric oxygen therapy than those over 50 years of age.
The American Academy of Head and Neck Medicine also recommends that patients with sensorineural hearing loss undergo hyperbaric oxygen therapy within three months.
Hyperbaric oxygen therapy
The rationale for using hyperbaric oxygen therapy in ISSHL is based on the understanding of the cochlea's high metabolic rate and sparse blood vessels. The cochlea and its internal structures require a large supply of oxygen. Direct vascular supply, especially to the organ of Corti, is very limited. Tissue oxygenation of the cochlear structures is achieved through the diffusion of oxygen from the cochlear capillary network to the perilymph and cortical lymph. The perilymph is the primary source of oxygen for these cochlear structures. Unfortunately, perilymph oxygen tension is significantly reduced in ISSHL patients. To achieve a sustained increase in perilymph oxygen content, the arterial-pericymph oxygen concentration difference must be very high, which can be restored through hyperbaric oxygen therapy.
Improve inner ear hypoxia
Hyperbaric oxygen therapy (HBOT) increases tissue oxygen concentration by increasing the partial pressure and dissolved oxygen content of plasma. Furthermore, HBOT can reduce hematocrit, decrease blood viscosity, and increase red blood cell elasticity, thereby improving microcirculation and significantly aiding in tissue perfusion and hypoxia. Studies show that HBOT can indeed increase the partial pressure of oxygen in the inner ear lymph. This effect should counteract the tissue damage caused by vascular factors in sudden deafness and may even increase the inner ear's tissue repair capacity.
Anti-inflammatory effects
Studies have shown that hyperbaric oxygen therapy has immunomodulatory effects, and recent research has further discovered that it can inhibit the function of adhesion molecules on leukocytes, reduce inflammatory responses, and thus reduce tissue damage caused by inflammation. Although no studies have yet explored the therapeutic effects of hyperbaric oxygen therapy on inner ear inflammation in sudden deafness, the potential anti-inflammatory effects of hyperbaric oxygen therapy may play a protective role in sudden deafness caused by viral infections.
Precautions for hyperbaric oxygen therapy
Hyperbaric oxygen therapy has many benefits for the body's repair process. However, if you need to undergo hyperbaric oxygen therapy, please note the following:
Treatment environment
Treatment should be performed in a professional hyperbaric oxygen chamber, and the equipment should be safety certified to ensure environmental safety and compliance with relevant standards.
Medical assessment
A comprehensive evaluation must be conducted before receiving hyperbaric oxygen therapy to understand the patient's medical history and current health status.
Follow medical guidance
Strictly follow the doctor's advice and plan for treatment, and avoid adjusting the course or frequency of treatment on your own.
Hyperbaric Oxygen Therapy Program - Diabetic Foot Ulcers
Hyperbaric oxygen therapy program – Diabetic foot ulcers
Diabetes is one of the most common non-communicable diseases in Hong Kong, with approximately 700,000 diabetic patients. Of these, 6% develop multiple diabetic complications, including diabetic foot. Diabetes ranks fifth among the top ten causes of death, and its incidence is increasing annually. Statistics show that 25% of diabetic patients seek medical attention for foot problems, and 15% will develop foot ulcers in their lifetime. Foot problems are also the most common reason for hospitalization among diabetic patients. Furthermore, approximately 45-70% of amputation cases are related to diabetes, demonstrating the profound impact of the disease's complications on patients.
The relationship between diabetic feet and diabetes
Diabetic foot is a complication of diabetes, usually caused by long-term high blood sugar leading to damage to blood vessels and nerves, which in turn affects blood circulation and sensory function in the feet.
Diabetic feet can be divided into 2 types：
- Neuropathic Ulcers
- Ischemic Ulcers
Causes of diabetic foot disease
The causes of diabetic foot disease can be mainly summarized into two categories: neurological disorders and foot ischemia.
Nervous system lesions
Neurological disorders can cause loss of normal sensation in the feet, which can lead to toe deformities and dry skin, making the toes more susceptible to injury.
Foot ischemia
Diabetes can also cause structural degeneration of blood vessels, disrupting blood circulation in the feet, which can hinder the healing process of foot injuries and increase the risk of bacterial infections.
Diabetic complications typically progress slowly, and patients often cannot detect any abnormalities in the early stages, only experiencing decreased or heightened sensation in the skin of their feet, especially in the toes. As the disease progresses, numbness and pain may gradually appear. The nature of the pain varies, including tingling, burning, a biting sensation, and a feeling like scalding water running through the skin, which may also be accompanied by a crawling sensation. Due to the loss of normal sensory function, patients' feet are easily injured or struck without their knowledge.
Treatment methods for patients with diabetic feet
The treatment principles for diabetic foot ulcers mainly include three parts:
1. Drug control
- Medications such as antibiotics are used to control infection, manage blood sugar, and promote wound healing, ensuring a stable condition.
- Maintaining stable blood sugar levels and taking prescription antibiotics can control bacterial infections, such as cellulitis.
2. Wound control
- Ulcers on the skin surface can be treated by washing, applying medication, and bandaging.
- Deeper and chronic ulcers are difficult to heal and require surgical debridement and restoration of local blood flow to improve blood supply to the foot. If poor blood supply to the tissue persists or the infection is not controlled, amputation may eventually be necessary to prevent more serious complications.
3. Hyperbaric oxygen therapy
- Hyperbaric oxygen therapy, as an effective adjunctive therapy, can reduce the risk of amputation, increase the chance of wound healing, and shorten the course of treatment.
What is hyperbaric oxygen therapy?
Hyperbaric oxygen therapy involves placing the patient in a completely sealed pressure chamber and inhaling pure oxygen at a pressure higher than normal (above 1.3 atmospheres absolute). The main purpose of hyperbaric oxygen therapy is to increase blood oxygen concentration, promote oxygen dissolution in the blood, and increase tissue oxygen content, thereby accelerating the body's self-repair and enhancing tissue oxygenation. It also utilizes physical principles to increase the oxygen dissolved in blood plasma.
As of July 2021, the FDA has approved the use of hyperbaric oxygen therapy to treat and improve non-healing wounds, such as diabetic foot ulcers.13 indications.
The effect of hyperbaric oxygen therapy on diabetic foot ulcers
Hyperbaric oxygen therapy can rapidly increase the body's oxygen concentration, promote angiogenesis, and activate hypoxic tissues, thus aiding in ulcer healing. Depending on the wound's condition, a course of treatment is recommended to be approximately 10 to 20 sessions; however, the specific number of sessions needs to be determined by a healthcare professional who understands the patient's condition and requirements.
A previous study randomly assigned 38 patients with non-healing diabetic foot ulcers (DFU) who were deemed unsuitable for vascular surgery to two groups: one group received regular hyperbaric oxygen therapy (HBOT). The results showed that 25% of the patients achieved complete closure of the DFU; the amputation rate in the HBOT group was 5%, significantly lower than in the general population who did not undergo HBOT (11%, χ² = 15.204, P = .010). Furthermore, their inflammation indices, blood flow, and health-related quality of life all showed significant improvements.
Hyperbaric Oxygen Therapy Program - Ischemic Stroke / Cerebral Stroke
Hyperbaric oxygen therapy program – Ischemic stroke / cerebral stroke
Stroke is one of the leading causes of death and disability worldwide, particularly as a part of cardiovascular disease. According to the World Health Organization, approximately 31% of the population died from these diseases in 2016, with 85% of those deaths attributed to heart disease and stroke. To raise public awareness of stroke prevention, the World Stroke Organization holds World Stroke Day annually on October 29th, urging attention to the prevention of risk factors.
Types of stroke
- Ischemic stroke：Ischemic stroke is caused by a blockage in a blood vessel. When the blood supply to the brain is interrupted, brain cells suffer from oxygen and nutrient deprivation, leading to death. It is mainly caused by narrowed blood vessels or loose blood clots. Ischemic stroke accounts for approximately 87% of all strokes.
- Hemorrhagic stroke (burst blood vessels)：Caused by a ruptured blood vessel, resulting in intracranial hemorrhage.
Symptoms of stroke
Stroke symptoms can lead to permanent sequelae, including:
- Paralysis
- Perception and language barriers
- Impaired memory
- Weakened thinking ability
- Incontinence
- Dysphagia
- Emotional problems and behavioral changes
Risk factors for stroke
- Old age
- Obesity
- High blood pressure
- Previous history of stroke or transient ischemic attack
- Diabetes mellitus
- High cholesterol
- Smoking
- Atrial fibrillation
Stroke treatment trends
The latest treatment trend is to seize the golden treatment period and implement hyperbaric oxygen therapy (HBOT) as early as possible to improve the chances of recovery.
Mechanism of action of hyperbaric oxygen therapy in the treatment of stroke
Acute ischemic stroke (AIS) is one of the leading causes of death worldwide, characterized by blockage of cerebral arteries. However, current treatment options for AIS remain limited. Hyperbaric oxygen therapy (HBOT) is considered an effective option for improving brain tissue hypoxia caused by AIS. The main goal of acute hyperbaric oxygen therapy is to increase oxygen levels in the ischemic area during stroke blockage, thereby reducing damage caused by hypoxia. Studies have shown that hyperbaric oxygen therapy can increase arterial blood oxygen partial pressure, increase oxygen content, stabilize the blood-brain barrier, reduce intracranial pressure, and alleviate cerebral edema. Furthermore, hyperbaric oxygen therapy is considered a safe treatment for acute ischemic stroke.
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