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Carbogen + nicotinamide is a combination radiosensitizing treatment used to enhance the efficacy of radiotherapy in various solid tumors, most notably muscle-invasive bladder cancer and laryngeal cancer. The combination consists of inhaled carbogen gas (typically 95-98% oxygen and 2-5% carbon dioxide) and oral nicotinamide (vitamin B3). This dual approach targets tumor hypoxia, a significant factor in radiotherapy resistance. Carbogen increases the amount of dissolved oxygen in the blood to counteract diffusion-limited (chronic) hypoxia, while nicotinamide acts as a vasoactive agent to improve tumor microperfusion and reduce perfusion-limited (acute) hypoxia. The combination is a key component of the BCON and ARCON treatment protocols and is considered a standard of care for bladder preservation therapy in the United Kingdom.
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