Study to Determine if Hyperbaric Oxygen Therapy is Helpful for Treating Radiation Tissue Injuries

NCT ID: NCT00134628

Last Updated: 2016-01-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE3

Total Enrollment

248 participants

Study Classification

INTERVENTIONAL

Study Start Date

2001-01-31

Study Completion Date

2015-12-31

Brief Summary

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The principle objective of this research is to more precisely determine the degree of benefit that hyperbaric oxygen therapy affords in the treatment of late radiation tissue injury.

The study has eight\* components. Seven involve the evaluation of established radionecrosis at varying anatomic sites (mandible, larynx, skin, bladder, rectum, colon, and gyn). The eighth will investigate the potential of hyperbaric oxygen (HBO) therapy to prophylax against late radiation tissue injury.

\*(One of the arms, HORTIS IV - Proctitis has been closed to further patient recruitment. This decision was based on an interim statistical analysis which generated sufficient evidence to support closing down this arm of HORTIS.)

Detailed Description

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Radiation therapy is a key component of the control and eradication of malignant disease. Adequate tumoricidal doses may, however, result in damage to surrounding healthy tissue. Therapeutic radiation injuries to non-target tissues can be divided into acute, sub-acute, and delayed complications. Acute injuries are considered a direct cellular toxicity, self-limiting, and in most cases successfully managed symptomatically. Sub-acute injuries are typically identifiable in only a few organ systems, e.g., radiation pneumonitis. These, too, are generally limited but occasionally evolve to late complications. Late changes occur several months to many years after completing radiotherapy.

The etiology of radiation's late effects to normal tissue (LENT) varies somewhat between organ systems. Its hallmark, however, is one of culminating in an obliterative endarteritis, and local hypoxia.

The incidence of LENT is related to both total radiation exposure and the length of time a patient is out from completing radiotherapy. The higher the dose, the longer the interval from exposure, the greater the risk. In many cases, resulting radionecrotic lesions seriously impair form and function, and require extensive surgical correction or repair. Such surgery is fraught with complications, hence the inclusion of a "prophylactic" hyperbaric oxygen arm. A disturbing degree of mortality further complicates the development of LENT.

Hyperbaric oxygen has been utilized in the treatment of radiation tissue injury for several decades. Most of the supportive basic science and clinical evidence stems from the management of mandibular osteoradionecrosis. More recently, the use of hyperbaric oxygen has been extended to other anatomic sites. This expanded use is based, in large part, on a presumed common underlying pathophysiology of LENT, regardless of its anatomic location. Supportive clinical evidence for these other sites is limited, however, and in need of a greater degree of scientific scrutiny.

Conditions

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Radiation Injuries

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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A

Hyperbaric Oxygen Therapy

Group Type ACTIVE_COMPARATOR

Hyperbaric Oxygen Therapy

Intervention Type PROCEDURE

HBO at 2.0 ATA

B

Normal Air

Group Type SHAM_COMPARATOR

Sham treatment

Intervention Type PROCEDURE

Normal air under pressure (1.1 ATA)

Interventions

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Hyperbaric Oxygen Therapy

HBO at 2.0 ATA

Intervention Type PROCEDURE

Sham treatment

Normal air under pressure (1.1 ATA)

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Endarteritis
* Hypovascularity
* Diarrhea
* Cramping
* Obstruction
* Stricture
* Pain
* Hemorrhage
* Wall Changes
* Ulceration
* Hypocellularity
* Mucosal thickening
* Vomiting
* Tenesmus
* Constipation
* Perforation
* Fistula
* Obstipation
* Tissue hypoxia

Exclusion Criteria

* Pregnancy
* Reactive airway disease
* Radiographic evidence of pulmonary blebs or bullae
* Untreated pneumothorax
* Previously documented ejection fraction less than 35%
* History of seizures except childhood febrile seizures
* Cardiovascular instability
* Mechanical ventilator support with the exception of those patients who are immediately (1-5 days) post-operative
* Unable to follow simple commands
* Not orientated to person, place, time
* Participating as a subject in any other medical or biomedical research project; if previously involved as a subject, sufficient time must have elapsed to permit "wash out" of any investigational agent.
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Baromedical Services

OTHER

Sponsor Role lead

Responsible Party

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Dick Clarke

President, National Baromedical Research Foundation

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Dick Clarke, CHT

Role: PRINCIPAL_INVESTIGATOR

National Baromedical Services

Locations

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Palmetto Health Richland

Columbia, South Carolina, United States

Site Status

Wesley Medical Center

Brisbane, Queensland, Australia

Site Status

Royal Hobart Hospital

Hobart, Tasmania, Australia

Site Status

Instituto Nacional de Cancerologica

Mexico City, , Mexico

Site Status

University of Stellenbosch

Cape Town, , South Africa

Site Status

University of Pretoria Medical Center

Pretoria, , South Africa

Site Status

Istanbul University Medical Center

Istanbul, , Turkey (Türkiye)

Site Status

Countries

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United States Australia Mexico South Africa Turkey (Türkiye)

References

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Curi MM, Dib LL. Osteoradionecrosis of the jaws: a retrospective study of the background factors and treatment in 104 cases. J Oral Maxillofac Surg. 1997 Jun;55(6):540-4; discussion 545-6. doi: 10.1016/s0278-2391(97)90478-x.

Reference Type BACKGROUND
PMID: 9191633 (View on PubMed)

Joseph DL, Shumrick DL. Risks of head and neck surgery in previously irradiated patients. Arch Otolaryngol. 1973 May;97(5):381-4. doi: 10.1001/archotol.1973.00780010393005. No abstract available.

Reference Type BACKGROUND
PMID: 4703530 (View on PubMed)

Samuels L, Granick MS, Ramasastry S, Solomon MP, Hurwitz D. Reconstruction of radiation-induced chest wall lesions. Ann Plast Surg. 1993 Nov;31(5):399-405. doi: 10.1097/00000637-199311000-00003.

Reference Type BACKGROUND
PMID: 8285524 (View on PubMed)

Hart GB, Mainous EG. The treatment of radiation necrosis with hyperbaric oxygen (OHP). Cancer. 1976 Jun;37(6):2580-5. doi: 10.1002/1097-0142(197606)37:63.0.co;2-h.

Reference Type BACKGROUND
PMID: 949677 (View on PubMed)

Marx RE. Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg. 1983 May;41(5):283-8. doi: 10.1016/0278-2391(83)90294-x.

Reference Type BACKGROUND
PMID: 6572704 (View on PubMed)

Marx RE. A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg. 1983 Jun;41(6):351-7. doi: 10.1016/s0278-2391(83)80005-6. No abstract available.

Reference Type BACKGROUND
PMID: 6574217 (View on PubMed)

Bevers RF, Bakker DJ, Kurth KH. Hyperbaric oxygen treatment for haemorrhagic radiation cystitis. Lancet. 1995 Sep 23;346(8978):803-5. doi: 10.1016/s0140-6736(95)91620-2.

Reference Type BACKGROUND
PMID: 7674746 (View on PubMed)

Woo TC, Joseph D, Oxer H. Hyperbaric oxygen treatment for radiation proctitis. Int J Radiat Oncol Biol Phys. 1997 Jun 1;38(3):619-22. doi: 10.1016/s0360-3016(97)00017-5.

Reference Type BACKGROUND
PMID: 9231688 (View on PubMed)

Williams JA Jr, Clarke D, Dennis WA, Dennis EJ 3rd, Smith ST. The treatment of pelvic soft tissue radiation necrosis with hyperbaric oxygen. Am J Obstet Gynecol. 1992 Aug;167(2):412-5; discussion 415-6. doi: 10.1016/s0002-9378(11)91421-5.

Reference Type BACKGROUND
PMID: 1497044 (View on PubMed)

Feldmeier JJ, Heimbach RD, Davolt DA, Brakora MJ. Hyperbaric oxygen as an adjunctive treatment for severe laryngeal necrosis: a report of nine consecutive cases. Undersea Hyperb Med. 1993 Dec;20(4):329-35.

Reference Type BACKGROUND
PMID: 8286987 (View on PubMed)

Other Identifiers

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ISRCTN85456814

Identifier Type: -

Identifier Source: secondary_id

Project HORTIS

Identifier Type: -

Identifier Source: org_study_id

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