What Researchers Did
Researchers performed a systematic review and meta-analysis of 13 studies comparing conservative treatments (including HBOT, antibiotics, and drug combinations) versus surgery for osteoradionecrosis (ORN) of the anterior and central skull base after head and neck cancer radiation.
What They Found
Conservative treatment, which included HBOT in some patients, resolved symptoms in only 8 of 197 patients (4.1%). Surgical treatment resolved symptoms in 135 of 188 patients (71.8%). Of those treated with vascularized tissue reconstruction surgery, 91.2% had full resolution. The data strongly favored surgery over medical treatment alone for this location of ORN.
What This Means for Canadian Patients
Head and neck cancer survivors who develop skull base bone death from radiation need to know that surgery, not HBOT alone, appears to offer the best chance of full recovery for this specific type of ORN. While HBOT can play a supportive role, waiting too long before pursuing surgery may allow the damage to worsen to a life-threatening degree. Canadians with this condition should be referred early to a head and neck reconstructive surgeon.
Canadian Relevance
Osteoradionecrosis is an OHIP-covered indication for HBOT in Ontario; however, this study's findings suggest HBOT alone is insufficient for skull base ORN and surgery should be prioritized.
Study Limitations
The 13 included studies were heterogeneous in staging, surgical technique, and HBOT protocols, and most were retrospective case series with no standardized treatment criteria.