BlueCross BlueShield of Tennessee Medical Policy Manual

Carbogen (95% Oxygen, 5% Carbon Dioxide) Inhalation in Cancer Treatment

DESCRIPTION

Carbogen is a mixture of 95% oxygen and 5% carbon dioxide and is inhaled as an adjunct to treatment for various oncologic applications. Tumors are generally hypoxic in nature and researchers theorize that increasing the tumor oxygenation during administration of chemotherapy or radiation treatments make the tumor more susceptible to the therapy being administered.

Carbogen is also known as Meduna's Mixture after its inventor Ladislas Meduna. Meduna's original formula was 30% CO2 and 70% oxygen.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

High-quality studies continue to be lacking in published literature that would validate the application of carbogen inhalation as an adjunct for the treatment of cancer.

SOURCES

Janssens, G.O., Rademakers, S.E., Terhaard, C.H., Doornaert, P.A., Bijil, H.P., van den Ende, P., et al. (2012). Accelerated radiotherapy with carbogen and nicotinamide for laryngeal cancer: results of a phase III randomized trial. Journal of Clinical Oncology, 30 (15), 1777-1783. (Level 2 evidence)

Janssens, G.O., Rademakers, S.E., Terhaard, C.H., Doornaert, P.A., Bijil, H.P., van den Ende, P., et al. (2014). Improved recurrence-free survival with ARCON for anemic patients with laryngeal cancer. Clinical Cancer Research, 20 (5), 1345-1354. (Level 2 evidence)

National Comprehensive Cancer Network. (2019, August). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®).  Prostate cancer. Retrieved December 16, 2019 from the National Comprehensive Cancer Network.

National Comprehensive Cancer Network. (2019, November). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®).  Bladder cancer. Retrieved December 16, 2019 from the National Comprehensive Cancer Network.

National Comprehensive Cancer Network. (2019, September). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®).  Cervical cancer. Retrieved December 16, 2019 from the National Comprehensive Cancer Network.

National Comprehensive Cancer Network. (2019, September). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®).  Head and neck cancers. Retrieved December 16, 2019 from the National Comprehensive Cancer Network.

Rademakers, S., Hoogsteen, I., Rijken, P., Terhaard, C., Doornaert, P., Langendijk, J., et al. (2015). Prognostic value of the proliferation marker Ki-67 in laryngeal carcinoma: results of the accelerated radiotherapy with carbogen breathing and nicotinamide phase III randomized trial. Head and Neck, 37 (2), 171-6. Abstract retrieved January 31, 2017 from PubMed database.

Yip, K., & Alonzi, R. (2013). Carbogen gas and radiotherapy outcomes in prostate cancer. Therapeutic Advances in Urology, 5 (1), 25-34. (Level 4 evidence)

ORIGINAL EFFECTIVE DATE:  4/1/2001

MOST RECENT REVIEW DATE:  1/9/2020  

ID_BT

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