For a review of other treatment options, skip down to CONVENTIONAL TREATMENT.

For a description of the hyperbaric oxygen alternative, skip down to HYPERBARIC ALTERNATIVE.

For details of a regimen pioneered at the Center, skip down to AIR-BREAK PROTOCOL.

In brain radionecrosis, the failure of steroids to control or even stabilize the dysfunction and the resulting neurologic deficit is problematic because few other treatment options exist. Other medical management alternatives include the use of nonsteroidal anti-inflammatory drugs to decrease vascular permeability, and anticoagulation therapy.^39,95,97 The use of these modalities is neither well studied nor widely accepted, and results have not been promising.⁶ Few studies have been published that evaluate enough patients to advocate with certainty the superiority of any one treatment modality, including corticosteroids or surgery.³⁷

If medical management fails to control the progression of injury, surgical resection of the affected portion of the brain is the only remaining option for stabilization of brain radionecrosis. This treatment modality is associated with high risk

and significant cost. Additionally, patients are candidates for such surgery only if their lesion is located in a surgically accessible region. Individuals with multiple foci or injury at an inoperable site are left with no therapeutic options. In this case, progression of the injury to a necrotic lesion and the continued steroid therapy result in worsening symptoms and eventually death.^6,18

In the absence of alternative treatments, researchers and doctors have been struggling with the problem of ameliorating the morbidity and mortality associated with brain radionecrosis that is unresponsive to medical management. Attempts at alternative treatments have met with little success with the singular exception of hyperbaric oxygen therapy, a treatment used for radiation injury in bone and soft tissue.

Hyperbaric oxygen therapy has been studied and is an accepted standard of care for adjunctive treatment of radiation injury to bone and soft tissue.^{55,68,69,70,74,88} However, few data have been published on its effects on neural tissue exposed to radiation, and it is not yet an accepted standard treatment for brain radionecrosis. Doctors and researchers at the Brain Radionecrosis Center have pioneered the use of hyperbaric oxygen therapy for brain radionecrosis through the development of an accelerated air-break treatment protocol. Using this protocol, we have treated the largest group of brain radionecrosis patients ever to undergo hyperbaric oxygen therapy. Our results show that the treatments are safe and effective with a high success rate.

Image 1. Hyperbaric chambers.

Prior to beginning a course of hyperbaric oxygen therapy, anticonvulsant regimens are optimized. Hyperbaric oxygen treatments are then given on a daily basis, five days a week. Before each treatment, patients are pre-medicated with a low dose of benzodiazepine.

Treatments are given in a monoplace hyperbaric chamber. Once a patient is situated in the chamber, it is pressurized. The pressure is maintained while the patient breathes 100% oxygen for a total of 90 minutes of oxygen consumption. The patient breathes air instead of oxygen at controlled intervals by means of a standard hyperbaric demand regulator. At the end of the treatment, the chamber is decompressed.

Patients continue daily treatments, five days a week, until their clinical status and neuroimaging findings resolve or plateau, until death, or until other contraindications are identified. Patients undergo comprehensive neurologic examinations and subjective assessments (history) weekly. An MRI with gadolinium is performed after each set of 20 treatments (i.e. at approximately four-week intervals).

Patients are followed up at between one month and six months to check for rebound effects after discontinuing hyperbaric oxygen therapy.

For the mechanism of action of hyperbaric oxygen therapy, jump to the HOW IT WORKS page.

For results among patients treated with hyperbaric oxygen therapy, jump to the OUTCOMES page.

For ongoing studies of hyperbaric oxygen therapy, jump to the RESEARCH page.