The Impact of Hyperbaric Oxygen Therapy on Pain Management in Cervical Squamous Cell Carcinoma

Abstract

Introduction: Radiation therapy is an established treatment for gynecological cancers but may cause delayed radiation injuries, including pelvic soft-tissue necrosis and severe pain. Pelvic radiation-related genitourinary complications occur in 17%–40% of women with cervical cancer. Hyperbaric oxygen therapy (HBOT) is used to treat delayed radiation injuries by improving tissue oxygenation and blood supply; however, its potential role in reducing severe pelvic radiation-associated pain is less well characterized. Case Presentation: A 51-year-old woman with cervical squamous cell carcinoma developed extensive pelvic radiation-associated necrosis, fistulization, and debilitating pelvic pain 25 months after radiotherapy. Her pain was rated 9/10 on the Numerical Rating Scale (NRS), was associated with substantial functional impairment and 2 previous suicide attempts, and required treatment with oral oxycodone. She underwent 30 HBOT sessions, administered once daily at 2.5 - 2.8 atmospheres absolute for 60 - 75 minutes per session. By the 15th session, her pain had decreased to an NRS score of 5/10, allowing her to resume daily activities and discontinue oral oxycodone. By the 30th session, her pain had further decreased to an NRS score of 3 - 4/10. Gynecological examination showed resolution of the previously observed necrotic tissue, except for a small mucosal area that had not yet been replaced by normal tissue. Conclusions: This case highlights the potential value of HBOT in promoting healing of radiation-associated pelvic tissue injury and reducing severe pain and its associated functional and psychosocial burden. Further studies are needed to determine whether this analgesic benefit is reproducible in patients with radiation-associated pelvic pain.