CHEST Guidelines-Successful-Healing-of-Tracheal-Radionecrosis

Successful-Healing-of-Tracheal-Radionecrosis_chest

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The article reports a novel case of successfully treating tracheal radionecrosis using hyperbaric oxygen therapy (HBOT), coupled with local debridement and antibiotic treatment. Tracheal radionecrosis is a rare complication of radiotherapy, as in this case involving a 55-year-old man previously treated for stage IIIB lung adenocarcinoma. Following chemotherapy and radiotherapy, which included the left lung and mediastinum, the patient developed neck pain, cough with mucopurulent sputum, and fever. Imaging revealed a fissure in the trachea wall, initially suggesting cancer recurrence. However, bronchoscopy ruled out cancer and confirmed tracheal ulceration with superimposed infection.<br /><br />The medical team opted for a tri-modal therapeutic strategy: administering antibiotics targeting multisensitive Staphylococcus aureus and Parvimonas micra, consistent local debridement using a bronchoscope, and 40 sessions of HBOT. HBOT has shown promise in enhancing angiogenesis and collagen synthesis, thereby promoting wound healing.<br /><br />This treatment strategy was chosen in light of HBOT's success in treating other radiation-induced injuries, such as laryngeal radionecrosis, where it can help in avoiding more radical procedures like tracheostomy or laryngectomy. Despite the absence of prior documented cases using HBOT for tracheal radionecrosis, its application here led to a full resolution of the tracheal ulcer and re-epithelialization without residual stenosis requiring intervention.<br /><br />The study emphasizes the importance of recognizing tracheal radionecrosis as a rare but treatable condition and highlights the potential of multimodal therapy. It underscores the beneficial synergy of HBOT, local debridement, and antibiotics in fostering patient recovery while avoiding invasive surgical procedures. This case not only marks the first documented use of HBOT for tracheal radionecrosis but also sets a precedent for non-surgical intervention in similarly complex cases.

Keywords

tracheal radionecrosis

hyperbaric oxygen therapy

HBOT

local debridement

antibiotic treatment

radiotherapy complication

lung adenocarcinoma

multimodal therapy

non-surgical intervention

bronchoscopy