HBOT and Radiotherapy: a collaboration between the Hospital Unit of Radiotherapy of the University-Hospital of Ferrara and the Department of Pathology, oncology and experimental medicine of the University of Ferrara and the Hyperbaric Centre of Ravenna.

By the end of August and the beginning of September, the Hyperbaric Centre hosted Professor Carlotta Giorgi, Dr Sonia Missiroli, Dr Mariasole Perrone and Dr Francesco Fiorica to perform healthy cells compression in the hyperbaric chamber that normally has the function to support the tumour growth.

We had a chat with him and Professor Giorgi of the Department of Pathology, Oncology and Experimental Medicine of the University of Ferrara on the research they carried out at our centre.

Dr Fiorica, can you tell us how the collaboration between you and the Ravenna Hyperbaric Centre came about?

We arrived at the Ravenna Hyperbaric Centre thanks to the direct professional collaboration between us and Dr Pasquale Longobardi. We have “real” patients that have been followed by the Hyperbaric Centre to treat damages caused by radiotherapy with good results.

Together with Dr Longobardi, in 2014 we organized a congress on radiotherapy toxicity management and on radiosensitivity increase that can derive from a combined use.

At the same time, there has been a collaboration between the Hospital Unit of Radiotherapy and the research group coordinated by Professor Giorgi of the Department of Pathology, Oncology and Experimental Medicine of the University of Ferrara, with important acquisitions on the cells behaviours after radiation.

Therefore, it became spontaneous to repeat the experiences acquired, by using hyperbaric therapy, with, I would say, great preliminary results.

Professor Giorgi, how the work was carried out at the Hyperbaric Centre and which results did you obtain?

The results are preliminary because we have just started and we expect to carry out other experiments to confirm the obtained data.

We treated in vitro cells (of mouse and man) with HBOT and then with radiotherapy; then we confronted them with the same cell cultures subject to radiotherapy.

Then we studied the activation of a specific inflammatory complex called inflammasome through the interleukin release. Preliminary data show that if we treat cells with HBOT before radiotherapy it is possible to prevent or reduce the inflammatory answer of the same radiotherapy, which we know it can be potentially harmful. For data validation, always in-vitro, we worked with co-cultures (healthy and sick cells) and we noticed that if we treat healthy cells only with radiotherapy, these produce signals that can induce growth in neoplastic cells. Conversely, if the same healthy cells are pre-treated with HBOT and then radiated, we can manage to stop this phenomenon. We suppose that this can be the basis of the major efficacy of radiotherapy proceeded by HBOT.

Dr Fiorica, what is the purpose of your study?

In clinical practice, there always have been results deriving from the association between radiotherapy and hyperbaric therapy and we always had an outcome with association improvement.

The main purpose is trying to understand why this happens and why it occurs in some patients and not in others. Moreover, the purpose is to understand, in the last analysis, why some tumours answer and others don’t.

Classical radiobiology says that these different answers are linked to a tumour. However, we think that, and we are trying to carry forward this hypothesis, that a tumour contributes to it, but only in a certain way, because what affects it is the environment where a tumour grows.

We are trying to understand how the surrounding environment after HBOT and before radiotherapy changes.

At the moment, our experiences are only in vitro, according to the cellular mode, so we should switch to the animal model and only then, if the results were confirmed, we might go on with a study on man.

What changes with this new method you are testing?

The main change deals with the research of a radiotherapy optimization through treatment customization. Therefore, the right treatment, the right person, the right tumour and the right moment are the only conditions in tumour control and in toxicity decrease.

All these experiences allow us to better understand biological mechanisms that are at the base of the answer to radiotherapy; this allows us to obtain a “guided by biology” radiotherapy and not only by technological progress.

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