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A Randomised Clinical Trial to Compare the Efficacy of Hyperbaric Oxygen Therapy with Neoadjuvant Chemotherapy with Neoadjuvant Chemotherapy Alone for Carcinoma Breast: a Pilot Study

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Abstract

Hypoxia plays a major role in cell survival, angiogenesis, glycolytic metabolism and metastasis in breast cancer. Hyperbaric oxygen therapy (HBOT) has a well-established effect for attenuating the effects of hypoxia by enhancing the effects of chemotherapy drugs and increasing oxygen delivery to the tissues. The hypoxic environment encourages cancer cells to acquire stemness and become resistant to chemotherapeutic drugs. We have used HBOT as an adjunct to neoadjuvant chemotherapy in breast cancer patients with the objective of reducing tumour hypoxia and improving the response to chemotherapy. A randomised controlled trial was conducted in patients with breast cancer. The patients were randomly allocated into the study group receiving neoadjuvant chemotherapy (NAC) with HBOT and the control group who received NAC only. The NAC consisted of 3 cycles of intravenous injection of cyclophosphamide, 5-fluorouracil and epirubicin. The HBOT was administered along with the chemotherapy in 3 sessions in each cycle at graded pressures in each sessions. Ultrasound evaluation of patients was carried out and breast tumour size was measured after every cycle of HBOT. All the patients were operated after 3 cycles of chemotherapy and modified radical mastectomy was carried out. The response of therapy was recorded in both the groups. Patients receiving HBOT achieved significantly higher percentage reduction of tumour volume (43.1%) and the largest dimension (80.21%) (p < 0.0001) compared with those receiving chemotherapy alone. Trial registry: CTRI/2019/03/018258

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References

  1. Ghoncheh M, Pournamdar Z, Salehiniya H (2016) Incidence and mortality and epidemiology of breast cancer in the world. Asian Pac J Cancer Prev 17(S3):43–46

    Article  Google Scholar 

  2. Malvia S, Bagadi SA, Dubey US, Saxena S (2017) Epidemiology of breast cancer in Indian women. Asia Pac J Clin Oncol 13(4):289–295

    Article  Google Scholar 

  3. Cain H, Macpherson IR, Beresford M, Pinder SE, Pong J, Dixon JM (2017) Neoadjuvant therapy in early breast cancer: treatment considerations and common debates in practice. Clin Oncol (R Coll Radiol) 29(10):642–652

    Article  CAS  Google Scholar 

  4. Man VC, Cheung PS (2017) Neoadjuvant chemotherapy increases rates of breast-conserving surgery in early operable breast cancer. Hong Kong Med J 23(3):251–257

    PubMed  Google Scholar 

  5. Daruwalla J, Christophi C (2006) Hyperbaric oxygen therapy for malignancy: a review. World J Surg 30(12):2112–2131

    Article  Google Scholar 

  6. Wenwu L, Xuejun S, Hengyi T, Kan L (2013) Hyperbaric oxygen and cancer: more complex than we expected. Target Oncol 8(2):79–81

    Article  Google Scholar 

  7. <A pilot study with long-term follow-up of hyperbaric oxygen pretreatment in patients with locally ad.pdf>.

  8. Moen I, Tronstad KJ, Kolmannskog O, Salvesen GS, Reed RK, Stuhr LE (2009) Hyperoxia increases the uptake of 5-fluorouracil in mammary tumors independently of changes in interstitial fluid pressure and tumor stroma. BMC Cancer 9:446

    Article  Google Scholar 

  9. Pande S, Sengupta A, Srivastava A, Gude RP, Ingle A (2012) Re-evaluate the effect of hyperbaric oxygen therapy in cancer - a preclinical therapeutic small animal model study. PLoS One 7(11):e48432

    Article  CAS  Google Scholar 

  10. Bennett MH, Feldmeier J, Smee R, Milross C (2018) Hyperbaric oxygenation for tumour sensitisation to radiotherapy. Cochrane Database Syst Rev 4:CD005007

    PubMed  Google Scholar 

  11. Petre PM, Baciewicz FA Jr, Tigan S, Spears JR (2003) Hyperbaric oxygen as a chemotherapy adjuvant in the treatment of metastatic lung tumors in a rat model. J Thorac Cardiovasc Surg 125(1):85–95 discussion

    Article  CAS  Google Scholar 

  12. Moen I, Stuhr LE (2012) Hyperbaric oxygen therapy and cancer--a review. Target Oncol 7(4):233–242

    Article  Google Scholar 

  13. Kim JY, Lim JE, Jung HH, Cho SY, Cho EY, Lee SK et al (2018) Validation of the new AJCC eighth edition of the TNM classification for breast cancer with a single-center breast cancer cohort. Breast Cancer Res Treat 171(3):737–745

    Article  Google Scholar 

  14. <[High-dose CEF (cyclophosphamide, epirubicin, fluorouracil) as primary chemotherapy in locally advan.pdf>.

  15. Kitajima K, Miyoshi Y, Yamano T, Odawara S, Higuchi T, Yamakado K (2018) Assessment of tumor response to neoadjuvant chemotherapy in patients with breast cancer using MRI and FDG-PET/CT-RECIST 1.1 vs. PERCIST 1.0. Nagoya J Med Sci 80(2):183–197

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Kondo Y, Hamada J, Kobayashi C, Nakamura R, Suzuki Y, Kimata R et al (2005) Over expression of hypoxia-inducible factor-1alpha in renal and bladder cancer cells increases tumorigenic potency. J Urol 173(5):1762–1766

    Article  CAS  Google Scholar 

  17. Cho KH, Yu SL, Cho DY, Park CG, Lee HY (2015) Breast cancer metastasis suppressor 1 (BRMS1) attenuates TGF-beta1-induced breast cancer cell aggressiveness through downregulating HIF-1alpha expression. BMC Cancer 15:829

    Article  Google Scholar 

  18. Wigerup C, Pahlman S, Bexell D (2016) Therapeutic targeting of hypoxia and hypoxia-inducible factors in cancer. Pharmacol Ther 164:152–169

    Article  CAS  Google Scholar 

  19. Takiguchi N, Saito N, Nunomura M, Kouda K, Oda K, Furuyama N et al (2001) Use of 5-FU plus hyperbaric oxygen for treating malignant tumors: evaluation of antitumor effect and measurement of 5-FU in individual organs. Cancer Chemother Pharmacol 47(1):11–14

    Article  CAS  Google Scholar 

  20. Stuhr LE, Iversen VV, Straume O, Maehle BO, Reed RK (2004) Hyperbaric oxygen alone or combined with 5-FU attenuates growth of DMBA-induced rat mammary tumors. Cancer Lett 210(1):35–40

    Article  CAS  Google Scholar 

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Acknowledgements

I thank Dr. Anurag Srivastava, my mentor, Head of Department of Surgical Discipline at AIIMS, Delhi, for taking special interest in my study and contributing to the editing and proofreading of the manuscript. I thank Dr. Puru Bansal, Dr. Sandeep Sharma, Rajendra Aphale, Dr. Sandip Parmar for their valuable inputs.

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  1. Department of General Surgery, Government Medical College and Sir Takhtasinhji Hospital, Bhavnagar, 364001, India

    Rijuta Aphale & Samir M. Shah

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  1. Rijuta Aphale
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  2. Samir M. Shah
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Correspondence to Rijuta Aphale.

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Aphale, R., Shah, S.M. A Randomised Clinical Trial to Compare the Efficacy of Hyperbaric Oxygen Therapy with Neoadjuvant Chemotherapy with Neoadjuvant Chemotherapy Alone for Carcinoma Breast: a Pilot Study. Indian J Surg 83 (Suppl 2), 511–515 (2021). https://doi.org/10.1007/s12262-020-02601-4

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  • DOI: https://doi.org/10.1007/s12262-020-02601-4

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