The purpose of this report was to investigate the efficacy of hyperbaric
oxygen treatment in the management of a persisting radiation induced
ulcer following standard breast irradiation. A 57-year-old Caucasian patient was referred following
partial mastectomy and axillary node clearance for a T2N0 grade 3 infiltrating
ductal carcinoma of the left breast. She received 45 Gy in 25 fractions at 1.8 Gy per fraction to the isocentre to the whole breast using tangential fields and 4 MV photons, in conjunction with intravenous
chemotherapy (
cyclophosphamide,
methotrexate and
5 fluorouracil). Treatment was interrupted for 3.5 weeks because of a grade 4 skin and subcutaneous reaction. Treatment resumed to the tumour bed alone.
Chemotherapy was abandoned. 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, completing treatment on 7 July 1998. The radiation induced a painful 8x4 cm
ulcer which persisted in spite of rigorous treatment including
Gentian Violet, Silvazine Cream,
Duoderm and
antibiotics. The patient received 30 hyperbaric treatments, six times a week, completing treatment on 15 December 1998. The patient required insertion of bilateral ear grommets under local anaesthetic. The breast
ulcer showed a response to treatment with early healing after 7-8 days and clinical evidence of re-epithelization. At completion of 30 treatments the patient was left with a small shallow faintly discharging multilocular 3-4 cm
ulcer. The
ulcer had completely healed by 14 January 1999. The patient has been symptom free since completion of treatment. This report highlights the efficacy of
hyperbaric oxygen therapy in the management of persisting radiation-induced
ulcers.