Safe administration of hyperbaric oxygen after bleomycin a case series of 15 patients

Klaus D. Torp, Martha Sue Carraway, Michael C. Ott, Bryant W. Stolp, Richard E. Moon, Claude A. Piantadosi, John J. Freiberger

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Introduction: Supplemental oxygen has been reported to cause pulmonary complications after bleomycin. We describe the safe administration of hyperbaric oxygen (HBO2) after bleomycin in 15 patients. Methods: Paper and electronic records were reviewed for bleomycin-exposed patients at the Duke Center for Hyperbaric Medicine and Environmental Physiology from 1979 to 2010. Results: Fourteen bleomycin-exposed patients received HBO2 at Duke under a special-precautions protocol. One was treated for DCS elsewhere. The protocol included: pretreatment evaluation; chest radiograph; spirometry; blood gases; a single, 2-atmospheres absolute (atm abs), 120-minute HBO2 treatment; and a gradual acceleration over one week to a twice-daily schedule contingent on clinical and laboratory findings. Bleomycin indications were: head-and-neck squamous cell carcinomas (11), Hodgkin's lymphoma (2), other carcinomas (2). HBO2 indications were: osteoradionecrosis (10), soft-tissue radionecrosis (3), DCS (1) and a provocative oxygen toxicity test for a military aviator (1). Total bleomycin doses ranged from 40 to 225u/m 2 (mean ± SD, 105 ± 57) given in conjunction with other chemotherapies and/or radiation. Radiation was 63.3 ± 31.72 Gy (mean ± SD), none to the chest with the exception of one patient treated for DCS elsewhere. Other chemotherapies included: vinblastine (11), methotrexate (11), CCNU (6) cisplatinum (7), dacarbazin (2), Adriamycin (1), and vincristine (1). Median age at time of HBO2 was 52 years (range 22-77). Median bleomycin-to-HBO2 latency was 34 months (range 1-279). Three patients received HBO2 within six months, and seven patients received HBO2 within two years of their last bleomycin exposure. There were no adverse pre-to-post HBO2 changes in: arterial blood gases, spirometry, chest radiograph findings or clinical reports. There were no persistent post-HBO2 pulmonary complications on follow-up. Post-HBO2 data were available for 40%, 53%, 87% and 100% of these parameters respectively. Discussion: Bleomycin and oxygen can individually cause acute pulmonary toxicity. However, evidence for increased long-term susceptibility based on their synergy may be overstated.

Original languageEnglish (US)
Pages (from-to)873-879
Number of pages7
JournalUndersea and Hyperbaric Medicine
Volume39
Issue number5
StatePublished - Sep 1 2012

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Physiology (medical)

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