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.
- Marx RE, Johnson RP, Kline SN. Prevention of osteoradionecrosis: A randomized prospective clinical trial of hyperbaric oxygen versus penicillin. J Am Dent Assoc 1985;11:49-54.
- Hart GB, Mainous EG. The treatment of radiation necrosis with hyperbaric oxygen. Cancer 1976;37:2580-2585.
- Feldmeier JJ, Heimbach RD, Davolt DA, Brakora MJ. Hyperbaric oxygen as an adjunctive treatment for severe laryngeal necrosis: A report of nine consecutive cases. Undersea Hyper Med 1993;20:329-335.
- Marx RE. Radiation injury to tissue. In: Kindwall EP, ed. Hyperbaric Medicine Practice. Flagstaff, Best Publishing, 1995, pp 464-503.
- Feldmeier JJ, Newman R, Davolt DA, Heimbach RD, Newman NK, Hernandez LC. Prophylactic hyperbaric oxygen for patients undergoing salvage for recurrent head and neck cancers following full course irradiation (abstract). Undersea Hyper Med 1998;25(Suppl):10.
- Feldmeier JJ, Heimbach RD, Davolt DA, Court WS, Stegmann BJ, Sheffield PJ. Hyperbaric oxygen as an adjunctive treatment for delayed radiation injury of the chest wall: A retrospective review of twenty-three cases. Undersea Hyper Med 1995;22(4):383-393.
- Bevers RF, Bakker DJ, Kurth KH. Hyperbaric oxygen treatment for haemorrhagic radiation cystitis. Lancet 1995;346:803-805.
- Woo TCS, Joseph D, Oxer H. Hyperbaric oxygen treatment for radiation proctitis. Int J Radiat Oncol Biol Phys 1997;38(3):619-622.
- Warren DC, Feehan P, Slade JB, Cianci PE. Chronic radiation proctitis treated with hyperbaric oxygen. Undersea Hyper Med 1997;24(3):181-184.
- Feldmeier JJ, Heimbach RD, Davolt DA, Court WS, Stegmann BJ, Sheffield PJ. Hyperbaric oxygen as an adjunctive treatment for delayed radiation injuries of the abdomen and pelvis. Undersea Hyper Med 1997;23(4):205-213.
- Feldmeier JJ, Heimbach RD, Davolt DA, Stegmann BJ, Sheffield PJ. Hyperbaric oxygen as an adjunct in the treatment of delayed radiation injuries of the extremities (abstract). Undersea Hyper Med 1998;25(Suppl);9.
- Fontanesi J, Golden EB, Cianci PC, Heideman RL. Treatment of radiation-induced optic neuropathy in the pediatric population. Journal of Hyperbaric Medicine 1991;6(4):245-248.
- Chuba PJ, Aronin P, Bhambhani K, Eichenhorn M, Zamarano L, Cianci P, Muhlbauer M, Porter AT, Fontanesi J. Hyperbaric oxygen therapy for radiation-induced brain injury in children. Cancer 1997;80:2005-2012.
- Pomeroy BD, Keim LW, Taylor RJ. Preoperative hyperbaric oxygen therapy for radiation induced injuries. J Urol 1998;159:1630-1632.