Does the Annane paper (2004) signal the end of HBO for ORN?

The study reported by Annane1 is a bold attempt to answer a controversial issue. The study is improved by the use of placebo hyperbaric oxygen (HBO) thus making it double blind. At one year, the recovery in the HBO arm was 19.3% and 32.4% in the placebo arm. The fact that the trial ended early must question the value of HBO for osteoradionecrosis (ORN), but this might be its Achilles heel, as concerns about placebo HBO brought in a stringent and early interim analysis which led to its closure. In closing the trial early, surgeons might place too much weight on the findings and assume that the issue of HBO in ORN has been put to rest once and for all. I wish to express caution with this view. Can you really decide policy on the basis of a single trial with 30 patients in each group? This study rather than signalling the end of evaluating the merits of HBO in the management of patients following radiotherapy to the jaws, highlights the need for an adequately funded and robust randomised trial in the UK.