Radiation Tissue Injury

Radiation injury to tissues (radionecrosis, radiation necrosis, osteoradionecrosis) is a complication or "side effect" of radiation therapy for a tumor. This occurs because the radiation can damage normal cells as well a tumor cells. Destruction of nutrient blood vessels in the irradiated area can result in local poor or non-healing wounds (ulceration), destruction of bone (necrosis) and bleeding.

Types of radiation injury

Radiation therapy for pelvic or abdominal tumors may result in bleeding or other symptoms. Bleeding from the bladder (radiation cystitis), small bowel (radiation enteritis) or rectum (radiation proctitis) are the most common complications. Symptoms of frequency, urgency, pain, incontinence and diarrhea may be experienced as well.

Radiation treatments for head and neck cancer can cause long term damage (necrosis) to the jaws, teeth and throat. Local non-healing wounds (ulceration) and decaying teeth (dental carries) are the most common side effects but may also include difficulty eating or swallowing, dry mouth or hoarseness. 

Radiation of the chest for breast or lung cancer may result in soft tissue radionecrosis of the chest wall with symptoms of reduced range of motion or swelling of the lymph nodes.

Treatment with hyperbaric medicine

Hyperbaric oxygen (HBO2) is effective treatment for radiation tissue injury. Since the 1970s, surgeons of the head and neck region have come to recognize the value of hyperbaric oxygen treatments in treating radiation therapy damage of the jaw bone. Hyperbaric oxygen has had some of its most dramatic successes in treating or preventing damage to the jaw bone and is the treatment of choice for osteoradionecrosis. Hyperbaric oxygen therapy has also been used to treat radiation therapy damage of the brain, muscle and other soft tissues of the face and throat as well. 

Virginia Mason Center for Hyperbaric Medicine patients are seen at the Seattle Main Clinic. In Virginia Mason's extensive experience treating radiation injury to the bladder (cystitis), 82 percent of patients have improved. Among patients treated at Virginia Mason for injury to the bowel (enteritis) or rectum (proctitis), approximately 70 percent have shown improvement. No other treatment for radiation cystitis or radiation proctitis actually heals the injured tissue as well as hyperbaric oxygen therapy. 

Surgery in a previously irradiated field may be accompanied by wound healing problems. When such surgery is performed, the addition of hyperbaric oxygen treatment may reduce wound breakdown, postoperative wound infections, and shorten healing times.

Decisions to manage chronic radiation tissue injury with hyperbaric oxygen therapy should be made by your managing physician, in consultation with an experienced hyperbaric physician.

How it all works

While cancer specialists would irradiate only cancer cells if they could, healthy cells are unavoidably affected. Cells that have a high rate of growth, such as those in the bowel, bladder, mouth and throat, are more sensitive to radiation damage. While acutely damaged cells have enough repair abilities to return to normal, the chronic condition shows radiation caused scarring and narrowing of the blood vessels resulting in poor blood supply. 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. 

Hyperbaric oxygen uses high concentrations of oxygen to repair the damaged vessels and tissues. The air we breathe contains 21 percent oxygen. This can be increased to 100 percent if oxygen is breathed via a mask or hood (personalized oxygen tent surrounding your head). The body's oxygen supply can be increased by a further two or three times by entering a hyperbaric chamber and receiving 100 percent oxygen at increased pressure. Oxygen administered in this manner is dissolved in the blood stream and delivered to body tissues at a far greater concentration. This high dose of oxygen is carried in the patient's circulation to the site of injury to assist in the repair of not only the damage tissue but also to the damaged blood vessels as well.

During HBO2 therapy for radiation tissue injury, oxygen is administered as a series of 30 to 40 treatments. For long-lasting results, the entire series of treatments must be completed. These treatments take about two hours and are delivered once or twice daily.

The benefits to you include:

  1. Increasing oxygen promotes tiny new blood vessels to grow inside and around the radiation site. As you grow more blood vessels, more oxygen rich blood is able to reach the affected area.

  2. Decrease of swelling (edema) around the radiation site. Decreasing the swelling allows the blood to flow more freely to the area, bringing with it oxygen.

  3. High oxygen levels increases the ability of the ‘infection fighting’ cells (white blood cells) to kill bacteria.