Treating Late Radiation Tissue Injury with HBO Medicine

Radiation therapy is a powerful and often life-saving treatment used to target and destroy cancer cells.  While it can be effective against malignancies, it can also cause unintended damage to healthy tissues that surround the treatment site.  In some cases, this damage doesn’t show up until months or even years later, a condition known as delayed tissue injury, or late tissue injury.  For patients experiencing pain, tissue breakdown, or poor healing long after treatment ends, one promising and increasingly recognized therapy is HBO Medicine.

This specialized treatment has been used for decades in wound care, and it’s now gaining traction for treating complications from radiation. Also, many insurance plans, including Medicare, recognize its value and offer coverage under certain conditions.

What Is Delayed Radiation Injury?

Injury can occur in almost any tissue that has been exposed to therapeutic treatment, including the head and neck, pelvis, chest, or abdomen. Delayed injury refers to damage that appears months or even years after the initial treatment.  This injury is often progressive, with symptoms that may worsen over time. Common examples include:

• Radiation cystitis (inflammation or bleeding of the bladder)
• Radiation proctitis (damage to the rectum)
• Osteoradionecrosis (bone death, commonly in the jaw)
• Soft tissue necrosis
• Non-healing wounds
• Chronic pain or fibrosis

These injuries often involve damage to the small blood vessels in the area, leading to poor oxygenation, inflammation, and cell death, which collectively impair the tissue’s ability to heal.

How HBO Medicine Works

HBO Medicine involves breathing 100% pure oxygen in a pressurized chamber, typically at 2 to 2.5 times the normal atmospheric pressure. This process dramatically increases the amount of oxygen your blood can carry, flooding tissues with a level of oxygen that cannot be achieved simply breathing room or outdoor air.

In cases of delayed radiation injury, HBO Medicine promotes healing in a number of ways:

• Stimulates new blood vessel growth (angiogenesis) in damaged tissue
• Reduces inflammation and swelling
• Enhances white blood cell activity to fight infection
• Supports collagen formation and fibroblast activity for tissue repair
• Restores function to radiation-damaged microcirculation

Research has shown that tissues injured are often hypoxic (oxygen-deprived), and that this lack of oxygen is central to the development of chronic wounds and tissue necrosis.  HBO Medicine can reverse this hypoxia, giving the body the oxygen it needs to restart the healing process.

Evidence Supporting HBO Medicine for Injury

Multiple clinical studies support the effectiveness of HBO Medicine in treating delayed radiation injuries.

• A 2008 systematic review published in Cancer concluded that HBO Medicine improved healing in head and neck cancer patients experiencing osteoradionecrosis or soft tissue necrosis after radiation (Bennett et al., 2008)
• The HOT2 trial, a randomized controlled study published in The Lancet Oncology (2016), found that patients with pelvic radiation disease (including proctitis and cystitis) reported significant improvements in pain and quality of life following HBO Medicine (Clarke et al., 2016).
• The Undersea and Hyperbaric Medical Society (UHMS) has approved HBO Medicine for the treatment of several radiation-induced conditions, including the soft tissue radionecrosis and osteoradionecrosis.

While HBO Medicine is not a “magic bullet,” when used as part of a comprehensive care plan, it offers tangible improvements in tissue repair, function, and symptom relief.

Commonly Treated Radiation Injuries with HBO Medicine

1. Radiation Cistitis
   • Patients may experience hematuria (blood in urine), pain, or urgency.  HBO Medicine helps by restoring vascular integrity and reducing inflammation in the bladder wall.
2. Osteoradionecrosis (ORN) of the Jaw
   • A debilitating condition that can occur after head and neck radiation, ORN can lead to chronic infection and jawbone exposure.  HBO Medicine is frequently used pre- and post-surgery to improve outcomes.
3. Radiation Proctitis
   • Characterized by rectal bleeding, pain, and ulceration, this condition can respond well to a course of HBO Medicine.
4. Non-Healing Wounds After Radiation
   • In patients who have had surgical wounds or ulcers that won’t close due to prior radiation, HBO Medicine helps create an environment for successful healing.

Treatment Protocol and Expectations

HBO Medicine for radiation injuries typically involves 20 to 40 sessions, each lasting up to 90 minutes.  Treatments are usually administered once per day, five days a week.  Some patients may need additional ‘booster’ sessions depending on how their tissues respond.

Side effects are generally mild and may include ear pressure, temporary vision changes, or fatigue.  Serious complications are rare but can include barotrauma or oxygen toxicity seizures.

Insurance Coverage and Medical Necessity

Many commercial insurance providers, Medicare, and Medicaid cover HBO Medicine for specific conditions, including:

• Osteoradionecrosis
• Soft tissue radionecrosis
• Cystitis and proctitis
• Non-healing radiation-induced wounds

Coverage typically requires documentation that the injury is radiation-induced, not responding to conservative treatment, and that HBO Medicine is being prescribed by a qualified provider.

The Centers for Medicare & Medicaid Services (CMS) and most private insurers follow guidelines established by the UHMS, which outlines the approved indications for HBO Medicine.

Conclusion

For cancer survivors dealing with the long-term consequences of therapy, delayed injury can be frustrating, painful, and difficult to manage.  HBO Medicine offers a scientifically backed, non-invasive solution that can dramatically improve healing and quality of life.

If you or a loved one is suffering from a non-healing wound or tissue damage after therapy, talk with your oncologist or a specialist here at Swanson Hyperbarics.  With growing clinical support and insurance recognition, HBO Medicine is more accessible than ever, and for many patients, it offers a path to long-overdue relief.