In August of 1998, we began using hyperbaric oxygen therapy to treat individuals with brain radionecrosis. In the last six years, we have collected comprehensive data on 39 of our patients to construct the largest case series described to date.²⁹

Patients were:

     • Referred by neuro-oncologists, radiation
       oncologists, and neurosurgeons.

     • Evaluated for significant risk factors and
       contraindication for hyperbaric oxygen
       therapy.

Patients accepted into the studies:

     • Suffered from increasing subjective
       complaints with progressive neurological
       deterioration of either focal deficits
       or intractable seizures.

     • Showed progressive enhancement and/or
       edema on MRI.

Deteriorations both clinically and radiographically were unresponsive to escalating steroid dosages for all patients except two who were not taking them at the time of referral.

     1. Patient had developed a diffuse injury
        pattern without a focal necrotic lesion
        associated with edema. The referring
        physician did notconsider this an
        indication for steroids.

     2. Patient had recently had surgery on his
        cranium, and there was concern about
        concomitant infection, hence steroids were
        not indicated for this patient.

Two patients did not complete the first 20 hyperbaric treatments.

     1. Patient showed rapid tumor progression.

     2. Patient ceased hyperbaric oxygen therapy
        for non-medical reasons.

Of the 39 patients, the results were as follows:

     • 8 patients showed progression of tumor.

     • 1 patient developed a comorbid brain
        infection unrelated to tumor or brain
        radionecrosis.

     • 2 patients did not receive steroids.

     • 2 patients did not complete 20 treatments.

     • 1 patient showed progression of brain
        radionecrosis.

     • By the end of follow-up, the success rate in
        halting the progression of, or reversing the
        brain radionecrosis was approximately 90%.

     • Survival in our patients was 54%.

     • For those patients who died, survival ranged
        from about three months to two years.

Of the 1,744 treatments conducted on these 39 patients, no major complications were experienced, and the experience of minor complications (focal seizures) was 0.5%. Focal seizures were only seen in patients who had identical seizure prior to beginning treatment; hyperbaric therapy may have induced the seizures, or they may have been coincidental to the timing of treatments.

Use of hyperbaric oxygen therapy, through the protocol we have designed, appears to be safe and effective for the brain radionecrosis patient.