Hyperbaric oxygen therapy: A practical guide for gynecologic oncologists.

Hyperbaric oxygen therapy (HBOT) has several promising uses in the setting of gynecologic malignancy. Treatment for gynecologic malignancy frequently includes radiation, which can cause significant cell and tissue injury leading to long-term toxicities for patients. HBOT involves creating a high-pressure atmosphere in which the patient breathes 100% oxygen, which results in increased arterial pO2, vasodilation of hypoxic tissue, and decreased inflammatory cascades. This has been shown to be beneficial in treatment of common long-term toxicities associated with radiation. Response rates to HBOT are highest amongst patients with radiation cystitis (64-99%) and wound healing, necrosis, and fistula (50-100%). Significant benefit has also been seen in treatment of proctitis. HBOT has not shown any benefit in treatment of pain. Common risks of HBOT include middle ear barotrauma (42%) and sinus pressure, while more serious risks such as oxygen toxicity rarely occur. Patients should expect daily sessions for several weeks under the management of a certified HBOT provider.