Successful treatment of radiation induced breast ulcer with hyperbaric oxygen

The purpose of this report was to investigate the efficacy of hyperbaric ox ygen treatment in the management of a persisting radiation induced ulcer fo llowing standard breast irradiation. A 57-year-old Caucasian patient was re ferred following partial mastectomy and axillary node clearance for a T-2 N -0 grade 3 infiltrating ductal carcinoma of the left breast. She received 4 5 Gy in 25 fractions at 1.8 Gy per fraction to the isocentre to the whole b reast using tangential fields and 4MV photons, in conjunction with intraven ous chemotherapy (cyclophosphamide, methotrexate and 5 fluorouracil). Treat ment was interrupted for 3.5 weeks because of a grade 4 skin and subcutaneo us reaction. Treatment resumed to the tumour bed alone. Chemotherapy was ab andoned. The tumour bed received 14 Gy in 7 fractions at 2 Gy per fraction prescribed to the 100 % using 10 MeV electrons and a direct field, completi ng treatment on 7 July 1998. The radiation induced a painful 8 x 4 cm ulcer which persisted in spite of rigorous treatment including Gentian Violet, S ilvazine Cream, Duoderm and antibiotics. The patient received 30 hyperbaric treatments, six times a week, completing treatment on 15 December 1998. Th e patient required insertion of bilateral ear grommets under local anaesthe tic. The breast ulcer showed a response to treatment with early healing aft er 7-8 days and clinical evidence of re-epithelization. At completion of 30 treatments the patient was left with a small shallow faintly discharging m ultilocular 3-4 cm. ulcer. The ulcer had completely healed by 14 January 19 99. The patient has been symptom free since completion of treatment. This r eport highlights the efficacy of hyperbaric oxygen therapy in the managemen t of persisting radiation-induced ulcers. (C) 2001 Harcourt Publishers Ltd.