Potential therapeutic applications of medical gases in cancer treatment

Medical gases were primarily used for respiratory therapy and anesthesia, which showed promising potential in the cancer therapy. Several physiological and pathological processes were affected by the key gases, such as oxygen, carbon dioxide, nitric oxide, hydrogen sulfide, and carbon monoxide. Oxygen targets shrinking the tumor via hyperbaric oxygen therapy, and once combined with radiation therapy it enhances its effect. Nitric oxide has both anti- and pro-tumor effects depending on its level; at high doses, it triggers cell death while at low doses it supports cancer growth. The same concept is applied to hydrogen sulfide which promotes cancer growth by enhancing mitochondrial bioenergetics and supporting angiogenesis at low concentrations, while at high concentrations it induces cancer cell death while sparing normal cells. Furthermore, carbon dioxide helps induce apoptosis and improve oxygenation for cancer treatments by increasing the release of oxygen from hemoglobin. Moreover, high-dose carbon monoxide gas therapy has demonstrated significant tumor reductions in vivo and is supported by nanomedicine and specialized medicines to boost its delivery to tumor cells and the availability of hydrogen peroxide. Despite the promising potentials of these gases, several challenges remain. Gas concentrations should be regulated to balance pro-tumor and anti-tumor effects for gases such as nitric oxide and hydrogen sulfide. Furthermore, effective delivery systems, such as nanoparticles, should be developed for targeted therapy.