HBOT & Brain Cancer

Hyperbaric Oxygen Tested for Aggressive Brain Cancer
Released: 7/22/2011 9:00 AM EDT Source:Neurological Surgery, P.C.

Newswise — In a unique study, researchers at The Long Island Brain Tumor Center at Neurological Surgery, P.C. are examining whether hyperbaric oxygen therapy – breathing pure oxygen while in a pressurized chamber – may prove a useful addition to the current standard of care for patients newly diagnosed with glioblastoma, an aggressive brain cancer. The Phase II study is currently enrolling participants, and is being conducted at Neurological Surgery, P.C. offices in Nassau and Suffolk Counties, New York, as well as at Winthrop University Hospital, Mineola, NY.

“Malignant glioblastoma is the most aggressive type of brain cancer, and it generally has a poor prognosis,” says neuro-oncologist J. Paul Duic, MD, principal investigator on the study and co-director of The Long Island Brain Tumor Center. “Novel treatment strategies are clearly needed.”

Malignant brain tumors are the second leading cause of cancer deaths in people under 35, and the fourth leading cause of cancer death in people under 54. Glioblastoma is the most common and most aggressive primary (non-metastatic) type of brain cancer. Median survival for glioblastomas is 12-14 months, and only 26 percent of patients survive two years.

Patients enrolled in the study must be newly diagnosed with malignant glioblastoma, and have previously received brain tumor surgery, but not radiation or chemotherapy. All patients in the study will receive the current standard of care for those newly diagnosed with glioblastoma – temozolomide (Temodar®) plus radiation therapy – as well as hyperbaric oxygen therapy.

“We know that these brain tumors prefer a low-oxygen metabolic state, and there is evidence that this metabolic state may contribute to the tumors’ ability to resist the effects of radiation therapy and chemotherapy,” says Jai Grewal, MD, sub-investigator on the study and co-director of The Long Island Brain Tumor Center. “We want to see whether increasing the oxygen concentration of the tumor increases the effectiveness of standard therapy.”

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Duic and Grewal are also interested in evaluating the effect of this treatment
on patients’ quality of life and stress levels. Participants will be asked to complete several brief questionnaires.

Hyperbaric oxygen has shown some benefit in pre-clinical studies, and in two recent Japanese clinical trials. In the first clinical trial, published in 2006, Ogawa and colleagues found that patients who received radiation therapy immediately after hyperbaric oxygenation, combined with chemotherapy, had longer survival rates, relatively few adverse events and no late toxicities. In 2007, Kohshi and colleagues reported additional survival benefits with minimal additional toxicity for previously treated high-grade glioma patients who were given hyperbaric oxygen combined with stereotactic radiosurgery.

In the current study, which is the only one of its type underway in the U.S., patients will first receive blood and medical imaging tests. They will then be given six weeks of hyperbaric treatments combined with radiation (Monday-Friday) and chemotherapy with temozolomide, which they will take at home daily. They will then have four weeks off treatment, then resume
taking temozolomide on a monthly basis.

Study participants will receive the experimental hyperbaric therapy prior to each radiation
treatment during the initial six weeks of treatment. During the hyperbaric treatment, the patient will lie on a stretcher in a
hyperbaric chamber and breathe oxygen at greater than normal atmospheric pressure. Blood sugar measurements will be taken, and medical imaging tests will also be done.


Patient participation in the study lasts one year, unless the patient cannot tolerate further
treatment or side effects, or shows evidence of tumor
progression. Patients may also voluntarily withdraw from the study.

Study results will be compared with those from the recently published multi-center trial by Stupp and colleagues, which demonstrated that temozolomide, when added to radiation therapy, can prolong the lives of those newly diagnosed with glioblastoma. This study defined the current standard of care.

The Long Island Brain Tumor Center at Neurological Surgery, P.C. provides the most comprehensive care available on Long Island, with state-of-the-art facilities located across Nassau and Suffolk Counties. The Center offers a multi-disciplinary approach to treating brain tumors, provided by a team of more than 20 physicians and surgeons with various sub-specialties. The team works in concert with patients’ medical oncologists and other health care professionals, and treats primary brain and spinal tumors, as well as metastases and CNS lymphoma. The Center is currently conducting two clinical trials.

For more information on this or other brain tumor studies, please call Kerry McConie, RN, (516) 478-0010, or Julia Trojanowski, RN, (631) 864-3900.

About Neurological Surgery, P.C.

Neurological Surgery, P.C. is one of the New York City area’s premier neurosurgical groups, offering patients the most advanced treatments of brain and spine disorders. These include minimally invasive procedures such as stereotactic radiosurgery (Gamma Knife® and CyberKnife®), aneurysm coiling, neuro-endoscopy, spinal stimulators, carotid stents, interventional pain management, microdiscectomy, kyphoplasty, and X-STOP®. The practice’s physicians represent a range of surgical and nonsurgical specialties, combining compassionate care with highly specialized training. They are leaders in the region’s medical community, with appointments as chiefs of neurosurgery in some of Long Island’s best hospitals. NSPC offers eight convenient locations in Queens, Nassau and Suffolk Counties. For more information, call 1-800-775-7784 or visit www.NSPC.com.

HBOT and Breast Cancer

James Slaby, MD, discusses hyperbaric oxygen therapy's (HBO's) effect on breast cancer cells.

Photo: James Slaby, MD

The total metastatic load in the lung is reduced after HBO --— that’s one of the most significant new findings from a 2007 study. Despite the misconception that HBO could actually have cancer-enhancing effect, HBO is frequently administered to cancer patients.

In the 2007 study, Haroon, Patel, and Al-Mehdi decided to evaluate the growth of murine breast cancer cells in the lung after hyperbaric oxygen treatment in an experimental metastasis assay. To do this, young nu/nu mice were injected intravenously with 3x 10(3) 4T1-GFP tumor cells per g body weight followed by lung isolation, perfusion, and intact organ epifluorescence microscopy 1 to 37 days after injection. A group of animals (n=32) was exposed once daily for five days a week to 45 minutes of 2.8 ATA hyperbaric oxygen in a research animal chamber.

Control animals (n=31) were not subjected to HBO, but received similar intravenous administration of 3x 10(3) 4T 1- GFP tumor cells. Single tumor cells and colonies were counted in the subpleural vessels in areas of about 0.5 cm2 of lung surface [Haroon et al]. What Haroon et al found was that HBO treatment did not lead to an increase in the number of the large colonies or small colonies in the lungs. Instead, there was a significant reduction in the number of the large colonies when observed at varying periods of the time after hyperbaric treatment.

Most importantly, there was a significant decrease in large colony size in the HBO group during all periods of observation. The results indicate that HBO is not prometastatic for breast cancer cells, but, instead restricts the growth of large tumor cell colonies [Haroon et al]. One of the most significant new findings from the study was that the total metastic load (the combined mass of large colonies, small colonies, and the single cell colonies in the target organ) in the lung is reduced after HBO. What’s more, HBO treatment did not lead to an increase in the combined number of metastic foci in the lung. The load reduction was accomplished because the size of the colonies was limited states Haroon et al.

Studies reveal that there is no adverse effect of HBO on tumor growth. In fact, the research suggests that HBO may have an anti-cancer effect with breast cancer cells. Use of HBO in human breast cancer patients did not have any adverse effects in a recent long-term follow up study and is even considered for treating lymphedema associated with breast cancer surgery.

These findings represent good news for patients that have cancer and other issues that would benefit from HBO therapy. In the past we were hesitant to use HBO on patients with cancer for fear of encouraging tumor growth. Now, for example, a patient with breast cancer that needed radiation therapy and developed soft tissues radiation neurosis would benefit from HBO therapy. As a result, her healing ability after breast reconstruction would improve.

Dr. James Slaby is a plastic surgeon specializing in wound care and a panel physician at the Wound Healing & Hyperbaric Oxygen Center at Wooster Community Hospital.

Reference
Haroon ATMY, Patel M, Al-Mehdi AB. [2007]. Lung Metastatic Load Limitation with Hyperbaric Oxygen.
Undersea Hyperbaric Medicine, 34:2, 83-90.

MD News July/August 2011, Cleveland/Akron/Canton

High-dose HBOT 02 Therapy Extends Survival Window After Cardiopulmonary Arrest, Study Suggests

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ScienceDaily (July 16, 2008) — A ground-breaking study by researchers at the School of Medicine at LSU Health Sciences Center New Orleans published in the August 2008 issue of Resuscitation has major implications for the #1 cause of death of Americans -- sudden cardiac arrest.

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The researchers stopped the heart of laboratory swine kept at room temperature, declared them dead from cardiac arrest, waited 25 minutes, and then resuscitated them with high doses of oxygen using hyperbaric oxygen therapy. The American Heart Association statistics on sudden death have shown that if a patient's heart is not restarted within 16 minutes with CPR, medications, and electric shocks, 100% of patients die.

"To resuscitate any living organism after 25 minutes of heart stoppage at room temperature has never been reported and suggests that the time to successful resuscitation in humans may be extended beyond the stubborn figure of 16 minutes that has stood for 50 years," notes Dr. Keith Van Meter, Clinical Professor of Medicine and Chief of the Section of Emergency Medicine at LSU Health Sciences Center New Orleans, who led the study.

The study involved the use of three groups of laboratory swine. All swine underwent cardiac arrest for 25 minutes during which time they received no artificial breathing, CPR, medications, or electric shocks. After 25 minutes the swine were randomly divided into 3 groups. The first group remained at normal pressure. The second group was given standard-dose hyperbaric oxygen, and the third group was given high-dose hyperbaric oxygen, a dose that is nearly 1/3 more than the highest dose currently given to humans.

Advanced cardiac life support (ACLS) was started on animals in all groups for a two-hour resuscitation period. After the two-hour resuscitation period, four of the six animals in the high-dose hyperbaric oxygen group could be resuscitated. None of the subjects in the other groups were able to be resuscitated.

"The present study shows that short-term high-dose hyperbaric oxygen is an effective resuscitation tool and is safe in a small multiplace hyperbaric chamber," concludes Dr. Van Meter. "A rehearsed team can easily load a patient in cardiopulmonary arrest into a small multiplace chamber in the pre-hospital or hospital setting without interrupting CPR or advanced cardiac life support. Successful resuscitation at 25 minutes suggests that if high dose hyperbaric oxygen is used at the current ACLS limit of 16 minutes, a greater survival may be achieved in humans and allow application of more definitive treatment such as clot dissolving drugs."

The research team also included LSU Health Sciences Center New Orleans faculty Diana Barratt, MD, MPH, Heather Murphy-Lavoie, MD, Paul G. Harch, MD, James Moises, MD, and Nicolas Bazan, MD, PhD. and

Future studies are planned to further refine knowledge about this important addition to resuscitation and survival procedures.

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Neural Pathway

Neural Pathway

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A neural pathway is a neural tract connecting one part of the nervous system with another, usually consisting of bundles of elongated, myelin-insulated neurons, known collectively as white matter. Neural pathways serve to connect relatively distant areas of the brain or nervous system, compared to the local communication of grey matter...

Hyperbaric Oxygen reduces inflammation in the Neural pathways, stimulates patients own stem cells for myelin production and restores circulation of compressed nerves.

Stories of Hope: HBO & RSD

Stories of Hope

Weighing the Results: Patients and specialists share stories about Hyperbaric Oxygenation Therapy By Patricia McAdams While Hyperbaric Oxygenation Therapy (HBOT) promises relief to many individuals with Reflex Sympathetic Dystrophy (RSD) and Complex Regional Pain Syndrome (CRPS), everyone's experience with this therapy is different. Glenn J. Shamdas, 48, who has had CRPS for seven years, tried HBOT because of a recommendation from a friend after she received a complete remission. He was not helped. "I had a total of 20 sessions in four weeks - which is a commonly prescribed schedule. Unfortunately, in my case, no significant improvement was experienced." Dana Marsolino, 52, who was in two bad car accidents and is still in a lot of daily pain, found no relief either. "I tried the hyperbaric chamber four times and had to quit due to my bad shoulders and neck," she says. "I could not tolerate lying inside [the chamber] for that length of time, no matter how they adjusted the pillows." Laura Rentsch, 45, has a somewhat complicated story. She had 20 sessions over four weeks, but endured considerable side effects. "During the dives I would experience deep pain in my RSD leg that would subside when we got to the final depth. I would also experience vertigo frequently after the treatment." Rentsch said that her swelling calmed down and she had better range of motion in her foot for some time, but she had also been given two Pamidronate treatments prior to the HBOT. Pamidronate helps with constant deep bone pain and she believes this drug did help her. "Ultimately I cannot say the HBOT helped me, but I can't say that I would not recommend it to others. It may very well have helped me, but other contributing factors that lead to less swelling and better range of motion need to be considered. My treatments occurred during the summer and I generally have lower pain levels and better range of motion during warmer weather. And the Pamidronate did reduce the bone pain." Susan Rodriguez, who has been a certified hyperbaric specialist from San Bernardino, Calif., for many years, says that she has not heard of this problem before. Vertigo is an extremely unusual side effect. She suspects it may have been triggered if a patient had an underlying vestibular problem to begin with. It may have been a result of Rentsch's reaction to the Pamidronate. It could also be the result of compression or decompression or other underlying factors. Indeed, Rentsch had a severe reaction to the Pamidronate. It caused sudden hearing loss and extreme tinnitus - a loud roaring motor sound in her ears. Certain powerful medications, particularly those given by IV, as Pamidronate was given to Rentsch, can literally poison the ears of genetically susceptible individuals. Ear poisoning can affect one's hearing or balance, or both. In this case, it is possible that an underlying vestibular problem may have been present. A more common side effect of HBOT is claustrophobia. For some, like Deb Brown, 60, of north central Florida, claustrophobia was too big a hurdle to overcome. One session was quite enough, she says. There were only two very small sections of clear plastic in the particular chamber she was in that she could look out of during the session. "I dare say it felt like it had done some good," says Brown. "Perhaps had I been sedated with an extremely light sedation, I would have handled it better." According to Allan Spiegel, M.D., Palm Harbor, Fl., the claustrophobia problem is minimal for most of his patients, because his chambers are like clear glass. Still, about 10 percent of his patients struggle with this problem, as Brown did. He gives them sedation, however, if they need it. "Mild sedation works wonders," he says. "But one of my patients overcomes the problem by closing her eyes after she lies down on the cot, before being wheeled into the chamber. For some reason that makes a difference," he says. "And then we put some calming music on." There are several kinds of chambers used for HBOT. Spiegel uses Sechrist chambers in his medical center. Rodriguez, however, prefers Gulf Coast chambers, which she says are somewhat larger. Patients can sit in these chambers and they will be very comfortable. These chambers are 13 feet long and five feet around. "No one has ever become claustrophobic in our chambers because of the large size," she adds. While the effectiveness of this therapy may vary from individual to individual, for some, it has been a Godsend. Tanya Kee, now 33, had a knee injury in 1999, followed by surgery, which made the knee worse. She developed RSD in her leg, which put her into a wheelchair. About three years after her original injury, Kee learned about HBOT and went through 56 sessions with success for her right lower leg and foot. "Probably within a half dozen dives, I noticed a difference," she says. "Even my friends said that I looked amazing," she added, noting that oxygen affects so much of the body. Kee's leg improved slowly, but steadily. "After about two months I went from being in a wheelchair for the most part, to walking and being able to lead a much better life." Unfortunately, she had to stop therapy because she sustained a new injury to her arm at this time that caused her RSD to spread to her arm, neck, back, neck and right side. She said that HBOT increases blood flow in muscles and makes her muscles too painful. "Prior to that, though, it was a great experience," she says. "My leg has not worsened since then. It's still painful, but I don't use my wheelchair unless we go to Disney or places where we do a lot of walking." Elsie Eten, age 57, had suffered with RSD for nine years before she learned about HBOT. Eten, who Spiegel calls his "Poster Child," (See: Hyperbaric Oxygenation Therapy: Can it relieve your pain?) had endured years of medical procedures before she met Spiegel and began treatment. "I was at a point in my life with the RSD and pain that I was ready to try anything, or I was ready to die, because I could not take the pain anymore. "After the first few days I could feel the difference," she says. "I was feeling better, the pain was less, and I was taking less pain medication. "After four weeks, I was pain free for the first time in eight or nine years. I slowly quit taking Oxycontin, Loratab, and Zanax. About two weeks later - six weeks after I began therapy - I was pain free and drug free. I could not believe it! "I wanted to go back to nursing so badly that I think I went back too soon. As soon as I was off my medications I went back to work without getting my body back into shape and strong. After a month at work, my pain started to come back. After three months, I had to quit my job because of my pain. I had to start taking Laratab again too." Eten says she goes for HBOT treatments every five or six months and it still helps. She is unable to work, but she is able to go out with her husband sometimes and see friends. "Even though I am not cured of RSD, I feel like I got some of my old life back. I recommend HBOT for RSD. My doctor told me when you have chronic pain, it takes a lot of different modalities to keep the pain at a manageable level and I believe that." Connie Waltz, director of nursing at the Robert M. Lombard Medical Center in Columbia, Pa., where Eduardo Pace is being treated (See: Beyond Pain: Some hope for healing), has treated a number of individuals with RSD. "Absolutely, I would recommend Hyperbaric Oxygenation Therapy for RSD," she says, adding that the sooner a person starts HBOT after they have been diagnosed, the better. Patients who have had RSD for a long time are tough to treat. The two patients they had, who were newly diagnosed, had especially good results. "One person stopped after 10 treatments, because of financial reasons," says Waltz. "She saw amazing results. She could open her hand and use it. The swelling went down. The natural pink color returned, instead of a dusky blue. "The other person had it in his shoulder," she says. "Within 20 treatments, he had range of motion." Hyperbaric Oxygenation Therapy appears to be one more tool in the toolbox of managing chronic pain for many individuals. Like Spiegel and Waltz, Rodriguez is passionate about the ability of Hyperbaric Oxygenation Therapy to make a difference for patients with RSD. "RSD can shatter your life," she says. "Mothers can't be mothers. Husbands can't support their families. Kids can't lead normal lives. And no one believes you about the pain. "People's lives depend on this therapy," she says. "Integrated with other ongoing therapies, it holds real promise." source: http://www.rsds.org/4/stories/hbot_patient_storieshtml.htm

Angiogenesis: The Key to Hyperbaric Oxygen HBOT Therapy by Paul Harch, M.D.

Angiogenesis: The Key to Hyperbaric Oxygen HBOT Therapy

by Paul Harch, M.D.

Researchers continue to document an increasing number of acute and chronic drug effects of Hyperbaric Oxygen Therapy (HBOT). Acutely, HBOT corrects hypoxia [oxygen deprived], reduces edema, augments WBC-mediated bacterial killing, inhibits an aerobic bacteria, and profoundly decreases reperfusion injury. In chronic wounding HBOT induced effects are trophic: fibroblast proliferation, collagen deposition, epithelialization, and angiogenesis. The latter process is the basis for HBOT generated wound healing and the topic of this HBO on the Avenue.

ANGIOGENESIS, or new blood vessel growth, is critical to

wound healing. In normal wound management with minimal tissue destruction angiogenesis occurs without problems at the wound edge where a steep oxygen gradient exists. The stimulus for angiogenesis is hypoxia at the wound edge that causes various growth factors to be released from wound macrophages. This same hypoxia is responsible for retinopathy in newborns and preemies after abrupt withdrawal of supplemental oxygen and in newborn animals subjected to hypoxic environments. Hypoxia is similarly present in chronic or non-healing wounds, but the difference is that the oxygen gradient is very shallow. While no one has defined the exact slope of the shallow gradient, i.e. the distance over which oxygen reduction occurs in a non-healing wound, it is the usual underlying pathophysiology in most non-healing chronic wounds. Besides large vessel revascularization, to date only one therapy has been shown to consistently correct the shallow oxygen gradient and induce angiogenesis: HYPERBARIC OXYGEN THERAPY.

The best model so far developed to study shallow perfusion gradient wounds and the one in which HBOT's angiogenesis effects have been unequivocally demonstrated is irradiated tissue. External beam radiation causes a well-defined stereotypic delayed thrombosis of small blood vessels that is maximal at the center of the beam and tapers at the edges. Marx (1) exploited this wound in animals and humans to show that HBOT caused a progressive angiogenesis at the wound margin by generating a steep oxygen gradient with intermittent repetitive HBOT. Over a course of about 30 treatments new vessel growth infiltrated the wound and achieved pO₂'s of about 85% of control tissue. Similar HBOT angiogenesis has been achieved in animals by Manson (2), Rohr (3), Meltzer (4), Nemiroff (5), Zhao (6), and others. This is the underlying basis of all HBOT in chronic wounding and accounts for the ability to heal diabetic foot wounds, arterial insufficiency ulcers, traumatic ischemic wounds, bums, and other devascularized wounds, providing major arterial supply is not severely decreased. On reverse side is an example of HBOT's angiogenesis capability.

HBOT relieves hypoxia

Hyperbaric Oxygen Therapy relieves the oxygen starvation of the brain known as hypoxia. Since full blood circulation to specific areas of the brain is impaired, increasing the rate at which oxygen diffuses into all of the body's fluids increases the amount of oxygen carried to the hypoxic brain tissues. Oxygen enriched cerebrospinal fluid will help to repair any recoverable brain tissue that is intact but not functioning normal. In many cases, HBOT has shown these idling neurons have started to function more efficiently, producing long-term improvements in both brain and clinical function. With the improvement of micro circulation and the relief of any brain swelling, a patient can experience a reduction in spasticity and an improvement in cognitive ability, vision, gross and fine motor skills, hearing and speech.

The brain now has the ability to learn and to process thought into actions. Depending on the age at the time of injury, many times the therapies now are able to be put into action. The patient may also now be able to go through the many stages of neurological steps. This steps may be skipping, crawling, standing, reactions as the brain now is going through a catch up stage of learning. With the permanent new blood supply the effects of HBOT will go on and on.

Some patients will suddenly be able to put into action a certain physical therapy or neuro-therapy, which never seemed to have an influence before.

In some, the most significant improvements are often seen when the HBOT is over; in some cases weeks later. Sadly, sometimes HBOT does not get the life-saving recognition, acknowledgment, and credit it so well deserves.

Patrick and Susan Rodriguez CHT, EMT, DMT

Parents of Susie, Danielle, Renee

Recovered