When would you consider hyperbaric oxygen for skull base necrosis or temporal lobe necrosis following CNS/HN RT?

I agree with Dr. @Dr. First Last and would like to add a few details. If the patient is asymptomatic, there is a chance of regression of the necrotic lesion, and no therapy is indicated. In symptomatic patients, the first treatment line is steroids, and surgery if the lesion is resectable. The quest...

When there is no evidence of active tumor, no contraindication to HBOT, and no suitable response to a slow steroid taper plus/minus avastin. Would also consider Vitamin E, trental, and Boswellia. Consider LITT or surgery if those fail.

Kirste et al., PMID 21287538