rpmjResearch'n Practical Medicine JournalResearch and Practical Medicine Journal2410-1893"QUASAR", LLC10.17709/2409-2231-2015-2-1-84-94rpmj-46Research ArticleПереводные статьиTranslated ArticlesГИПЕРБАРИЧЕСКАЯ ОКСИГЕНАЦИЯ И РАК – ОБЗОР (ПЕРЕВОД С АНГЛ. МИТРОХИНА А.А.)HYPERBARIC OXYGENT HERAPY AND CANCER - A REVIEW.МоэнИ.MoenI.ingrid.moen@biomed.uib.noСтурЛ.StuhrI.Отделение биомедицины, Университет г. Бергена (Берген, Норвегия) 5009, Норвегия, г. Бергена, улица Йонаса Лиеса, 91НорвегияDepartment of Biomedicine, University of Bergen, Jonas Lies vei 91, 5009 Bergen, Norway.NorwayОтделение Физиологии, Университет г. Бергена (Берген, Норвегия) 5009, Норвегия, г. Бергена, улица Йонаса Лиеса, 91НорвегияDepartment of Physiology, University of Bergen, Jonas Liesv. 91, N-5009 Bergen, NorwayNorway201507042015218494Copyright © Моэн И., Стур Л., 20152015Моэн И., Стур Л.Moen I., Stuhr I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpmj.ru/rpmj/article/view/46

Предисловие к русскому переводу

В повседневной клинической практике нередко встречаются пациенты, которым показано лечение ГБО и имеющие в анамнезе или даже текущей истории болезни те или иные аспекты онкологии (в прошлом опухоль удалена или излечена консервативно, есть доброкачественные новообразования и т.д.). Профильные специалисты, и даже многие барологи, в подобных ситуациях однозначно возражают против включения ГБО в комплексную терапию. Но в настоящее время на высоком уровне доказательности установлено, что ГБО может помочь спасти конечность от ампутации, вернуть слух при острой нейросенсорной тугоухости, уменьшить койко-день при ожогах, помочь в заживлении проблемных ран и при многих других состояниях (всего Обществом Гипербарической и Подводной Медицины США одобрено 14 групп показаний). Насколько обоснованно мы лишаем специфической, не имеющей альтернативы терапии больных, в ней нуждающихся? В личном общении с профильными специалистами – высококлассными профессионалами в своих разделах медицины, можно услышать в основном причину, построенную на личном представлении о механизме действия гипербарического кислорода: заживляет раны – значит стимулирует рост клеток. И конечно же раковых. Однако в отечественной литературе последних лет нет данных о серьёзных исследованиях в этом направлении. Между тем за рубежом есть не только ряд таких исследований, но и обзоры, подробно суммирующие их результаты, в основном не совпадающие с устоявшимися в нашей стране представлениями. Перевод одного из этих обзоров представляется вниманию читателя.

Митрохин Андрей Анатольевич, к.м.н., заведующий отделением ГБО ГКБ им. С.П.Боткина, доцент кафедры анестезиологии и неотложной медицины РМАПО. E-mail: aadoctor@mail.ru

Резюме.

Гипоксия является важным свойством солидных опухолей, затрагивающим усиление жизнеспособности клеток, ангиогенез, гликолитический метаболизм и метастазирование. Более века лечение гипербарической оксигенацией (ГБО) применяли для облегчения или излечения заболеваний связанных с гипоксией и ишемией за счет увеличения количества кислорода, растворенного в плазме и, таким образом, повышения доставки О2 к тканям.  Исследования ГБО и рака до недавнего времени были сфокусированы на вопросе, действует ли повышенное содержание кислорода как стимулятор рака или нет. Поскольку кислород считается необходимым для всех основных процессов заживления ран, высказывались опасения, что эффект ГБО будет применим так же и к раковой ткани и будет усиливать ее рост. Более того, некоторые авторы опасались, что применение ГБО пациентам, получавшим лечение от рака, может привести к его рецидиву. Однако в двух системных обзорах, посвященных ГБО и раку, авторы пришли к заключению, что применение ГБО пациентам со злокачественными опухолями безопасно. С целью развития предшествовавших обзоров, мы суммировали работы, выполненные по теме ГБО и рак за период с 2004 по 2012. Исходя из результатов как предлагаемого, так и предыдущих обзоров, можно говорить о том, что нет данных, указывающих на стимуляцию роста опухоли или ее рецидивирования под действием ГБО. С другой стороны, есть данные за то, что применение ГБО может оказывать ингибирующее влияние на некоторые подтипы опухолей. Мы настоятельно полагаем, что нам необходимо расширять знания об эффектах и механизмах, сопровождающих оксигенацию опухоли.

Hypoxia is a critical hallmark of solid tumors and involves enhanced cell survival, angiogenesis, glycolytic metabolism, andmetastasis. Hyperbaric oxygen (HBO) treatment has for centuries been used to improve or cure disorders involving hypoxia and ischemia, by enhancing the amount of dissolved oxygen in the plasma and thereby increasing О2 delivery to the tissue. Studies on HBO and cancer have up to recently focused on whether enhanced oxygen acts as a cancer promoter or not. As oxygen is believed to be required for all the major processes of wound healing, one feared that the effects of HBO would be applicable to cancer tissue as well and promote cancer growth. Furthermore, one also feared that exposing patients who had been treated for cancer, to HBO, would lead to recurrence. Nevertheless, two systematic reviews on HBO and cancer have concluded that the use of HBO in patients with malignancies is considered safe. To supplement the previous reviews, we have summarized the work performed on HBO and cancer in the period 2004–2012. Based on the present as well as previous reviews, there is no evidence indicating that HBO neither acts as a stimulator of tumor growth nor as an enhancer of recurrence. On the other hand, there is evidence that implies that HBO might have tumor-inhibitory effects in certain cancer subtypes, and we thus strongly believe that we need to expand our knowledge on the effect and the mechanisms behind tumor oxygenation.

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The authors declare that there are no conflicts of interest present.