Delayed Radiation Injury (Soft Tissue and Bony Necrosis)

Cancer treatment has improved significantly over the past decade. Although cure of the cancer is still the highest priority of treatment, cancer specialists have come to recognize the ever-increasing importance of quality of life to the cancer survivor. One-half of the estimated 1.2 million new cases of invasive cancer will receive radiation therapy as a part of cancer treatment. Side effects of this therapy can be very toxic, especially when combined with chemotherapy. Some people are more sensitive to radiation damage than others, and there are no reliable tests available as yet to identify those patients who will experience the worst side effects. Radiation doses must be adequate to control the cancer; otherwise there is no purpose in treating the patient. Most radiation cancer specialists or oncologists design their treatment protocols to give the best dose to control the tumor and still have no more than 5 percent of patients develop severe reactions to treatment.

Radiation side effects are generally divided into two categories. First, there are those that happen during or just after the treatment, called acute reactions. Second, there are those that occur months or even years after the treatment, called chronic complications.

The acute side effects almost always resolve with time and are treated in such a way as to address the patient's symptoms. For example, when a patient has cancer of the mouth or throat, it becomes very difficult for the patient to eat during and just after radiation treatment because the lining of the mouth and throat becomes raw and painful. The cells which make up the linings of the gastrointestinal tract are sensitive to radiation. Both cancer cells and the cells that line the gastrointestinal tract have a high rate of growth, and this rapid growth rate makes them more sensitive to radiation damage. Fortunately, the normal tissue cells have excellent repair abilities and within a few weeks after the completion of radiation, this damage is repaired. In the meantime, the patient is supported with pain medicine and supplemental nutrition.

Unfortunately, chronic complications often may not get better with time and are likely to get worse. Almost all chronic radiation complications result from scarring and narrowing of the blood vessels within the area which has received treatment. If this process progresses to the point that the normal tissues are no longer receiving an adequate blood supply, death or necrosis of these tissues can occur. In the past, a severe level of necrosis would require surgical removal of the damaged tissue. This would be devastating for a patient whose cancer has been cured. For example, though it occurs rarely, a patient who has had cancer of the voice box cured might require the removal of the voice box due to radiation damage. Chronic radiation damage is called "osteoradionecrosis" when the bone is damaged and "soft tissue radionecrosis" if it is muscle, skin or internal organs which have been damaged by the radiation.

Since the 1970s, surgeons of the head and neck region have come to recognize the value of hyperbaric oxygen treatments in treating damage of the jaw bone due to radiation therapy. Hyperbaric oxygen has had some of its most dramatic successes in treating or preventing damage to the jaw bone as a result of radiation treatments. Now, hyperbaric oxygen therapy has been used to treat radiation therapy damage of the brain, muscle and other soft tissues of the face and throat, the chest wall, abdomen and pelvis. Medical journal articles also report success in treating radiation damage to the bladder (cystitis), intestines (enteritis) and rectum (proctitis). The high dose oxygen provided in the hyperbaric chamber is carried in the patient's circulation to the site of injury to assist in the repair of the damage done by the narrowing and scarring of the blood vessels. Each treatment typically takes one to two hours, and usually 30-40 daily treatments are needed for healing radiation damage.


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