***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Background Pelvic radiation therapy is an important element of curative therapy for gynaecological cancers . Serious radiation-related complications developing months or years after treatment are known as late radiation tissue injury ( LRTI ) . Methods We investigated the possible pain reducing effect of hyperbaric oxygen treatment ( HBOT ) in a study of 16 patients with LRTI after radiation for gynaecological malignancy . The 16 patients were registered prospect ively , underwent HBOT for 21 consecutive days and were followed for a 6-month period after treatment using the Brief Pain Inventory , Montgomery and Aasberg Depression Rating Scale , as well as registration of global patient scores , analgesic consumption and magnetic resonance imaging ( MRI ) findings . Results HBOT was shown to have insignificant effect on pain , pain characteristics , daily function , the use of analgesics and MRI-related tissue injury . Fifty percent of the patients still reported some or good effect of the treatment . Conclusion It is not possible to conclude from our study if gynaecological patients with pelvic pain will benefit from HBOT . The application of HBOT to selected patients may be justified , but further research with adequate sample size , as well as the timing of HBOT related to the development of LRTI , is required to establish the optimum patient selection AIM to evaluate the influence of HBOT to the side effect and quality of life  after pelvic radiation . METHODS this is an open r and omized , parallel , prospect i ve study conducted in Department of Obstetrics and Gynecology , Oncology Division and Department of Radiotherapy . Endoscopy procedure was performed in Department of Internal Medicine and tissue biopsy in Department of Pathology Anatomy . The hyperbaric oxygen therapy ( HBOT ) was done in Dr. Mintohardjo , Navy Seal Hospital Jakarta . The side effect was measured using LENT SOMA scale ratio , the quality of life used the Karnofsky score . The difference of two mean was analyzed using student t test . RESULTS of 32 patients undergoing HBOT and 33 patients as control , the ratio of ASE of control group was 44.1+/-28.2 % , HBOT group was 0.7+/-30.1 % ; p<0.001 ; the LSE of control group was 33.6+/-57.6 % , HBOT group was -19.6+/-69.4 % ; p=0.008 . Quality of life of control group after intervention was 4.5+/-10.7 % ; HBOT group was 19.7+/-9.6 % ; p < 0.001 . After 6 months of intervention the quality of life was 2.5+/-16.1 % in the control group , and HBOT group was 15.2+/-14.7 % ; p = 0.007 . CONCLUSION the study showed that HBOT decreased acute and late side effect , also improved the quality of life of patients with proctitis radiation We hypothesized that exposure to hyperbaric oxygen ( HBO(2 ) ) would mobilize stem/progenitor cells from the bone marrow by a nitric oxide ( * NO ) -dependent mechanism . The population of CD34(+ ) cells in the peripheral circulation of humans doubled in response to a single exposure to 2.0 atmospheres absolute ( ATA ) O(2 ) for 2 h. Over a course of 20 treatments , circulating CD34(+ ) cells increased eightfold , although the overall circulating white cell count was not significantly increased . The number of colony-forming cells ( CFCs ) increased from 16 + /- 2 to 26 + /- 3 CFCs/100,000 monocytes plated . Elevations in CFCs were entirely due to the CD34(+ ) sub population , but increased cell growth only occurred in sample s obtained immediately posttreatment . A high proportion of progeny cells express receptors for vascular endothelial growth factor-2 and for stromal-derived growth factor .  In mice , HBO(2 ) increased circulating stem cell factor by 50 % , increased the number of circulating cells expressing stem cell antigen-1 and CD34 by 3.4-fold , and doubled the number of CFCs . Bone marrow * NO concentration increased by 1,008 + /- 255 nM in association with HBO(2 ) . Stem cell mobilization did not occur in knockout mice lacking genes for endothelial * NO synthase . Moreover , pretreatment of wild-type mice with a * NO synthase inhibitor prevented the HBO(2)-induced elevation in stem cell factor and circulating stem cells . We conclude that HBO(2 ) mobilizes stem/progenitor cells by stimulating * NO synthesis A prospect i ve r and omized trial comparing hyperbaric oxygen and systemic antibiotics in the prevention of osteoradionecrosis was presented . The results indicated , in a high-risk population who required tooth removal in irradiated m and ibles , that up-front hyperbaric oxygen produced an incidence of osteoradionecrosis of 5.4 % as compared with the antibiotic group of 29.9 % ( P = .005 ) . Hyperbaric oxygen should be considered a prophylactic measure when post-irradiation dental care involving trauma to tissue is necessary From September 1968 to March 1974 , a r and omized clinical trial was carried out , using conventional fractionation , i.e. , five treatments per week , in 233 patients with advanced cancers of the uterine cervix — Stages IIB , IIIA IIIB and IVA . The age limit was 70 years and all patients had medical clearance .  Lymphangiography and , in some patients , an exploratory laparotomy with selective lymphadenectomy , were done prior to treatment to determine the extent of nodal disease . The staging has not been changed either by lymphangiogram or lymphadenectomy findings . A few patients with bulky Stage I and IIA lesions were entered into the trial because of extensive nodal disease demonstrated either by lymphangiogram and /or lymphadenectomy . First , the patients were grouped according to the clinical stage . The second stratification was according to the lymphangiogram and /or selective lymphadenectomy findings . The patients were then r and omized to air or hyperbaric oxygen within each group . The patients were pressurized in a Vickers chamber at 3 atmosphere absolute , using a 20‐minute soak time prior to the irradiation . The size of the external beam portal was determined by the status of the nodes . The difference in absolute NED ( no evidence of disease ) survival rates for both groups as a whole and by stages is not statistically significant . There is no difference in the incidence of failures in the irradiated area between the HPO and air patients . There is no increase in distant metastases in the HPO group . It does not seem that the HPO has had an effect on the major complications . However , there was an increase in the incidence of complications with extended fields . The addition of lymphadenectomy has increased the incidence of fatal complications , even with routine pelvic portals . The negative results of this trial with conventional fractionation should not lead to the conclusion that HPO could not be useful with schemes using few high dose fractions PURPOSE Cancer patients who undergo radiotherapy remain at life-long risk of radiation-induced injury to normal tissues . We conducted a r and omized , controlled , double-blind crossover trial with long-term follow-up to evaluate the effectiveness of hyperbaric oxygen for refractory radiation proctitis . METHODS AND MATERIAL S Patients with refractory radiation proctitis were r and omized to hyperbaric oxygen at 2.0 atmospheres absolute ( Group 1 ) or air at 1.1 atmospheres absolute ( Group 2 ) . The sham patients were subsequently crossed to Group 1 . All patients were re-evaluated by an investigator who was unaware of the treatment allocation at 3 and 6 months and Years 1 - 5 . The primary outcome measures were the late effects normal tissue-subjective , objective , management , analytic ( SOMA-LENT ) score and st and ardized clinical assessment . The secondary outcome was the change in quality of life . RESULTS Of 226 patients assessed , 150 were entered in the study and 120 were evaluable . After the initial allocation , the mean SOMA-LENT score improved in both groups . For Group 1 , the mean was lower ( p = 0.0150 ) and the amount of improvement nearly twice as great ( 5.00 vs. 2.61 , p = 0.0019 ) . Similarly , Group 1 had a greater portion of responders per clinical assessment than did Group 2 ( 88.9 % vs. 62.5 % , respectively ; p = 0.0009 ) . Significance improved when the data were analyzed from an intention to treat perspective ( p = 0.0006 ) . Group 1 had a better result in the quality of life bowel bother subscale . These differences were abolished after the crossover . CONCLUSION Hyperbaric oxygen therapy significantly improved the healing responses in patients with refractory radiation proctitis , generating an absolute risk reduction of 32 % ( number needed to treat of 3 ) between the groups after the initial allocation . Other medical management requirements were discontinued , and advanced interventions were largely avoided . Enhanced bowel-specific quality of life result ed 
    Output:
    
There is modest direct evidence and emerging indirect evidence that the use of HBO(2 ) is broadly effective for late radiation tissue injury of the pelvis in women treated for gynecologic malignancies .
CONCLUSIONS Based on the evidence and expert consensus opinion , HBO(2 ) is likely effective for late radiation tissue injury of the pelvis , with demonstrated efficacy specifically for radiation damage to the anus and rectum;the main indication for HBO(2 ) therapy in gynecologic oncology is in the management of otherwise refractory chronic radiation injury;HBO(2 ) may provide symptomatic benefit in certain clinical setting s ( for example , cystitis , soft-tissue necrosis , and osteonecrosis ) ; and HBO(2 ) may reduce the complications of gynecologic surgery in patients undergoing surgical removal of necrosis