Hyperbaric Oxygen Therapy for Radiation Injury
HBOT is FDA-approved for soft tissue and bone damage caused by radiation therapy. Learn about osteoradionecrosis, radiation proctitis, and treatment protocols.
Hyperbaric Oxygen Therapy for Radiation Injury
The FDA has cleared hyperbaric oxygen therapy (HBOT) for soft tissue and bone radiation injury, also called late radiation tissue injury (LRTI).
Radiation therapy saves lives. But it can also damage the surrounding healthy tissue. That damage sometimes shows up months or even years after treatment ends. HBOT is one of the few treatments that directly addresses what radiation does to tissue. Learn more about how HBOT works.
How Radiation Damages Tissue Over Time
Radiation doesn’t just kill cancer cells. It also injures nearby blood vessels, connective tissue, and bone. Over time, this creates what doctors call the “3H” tissue environment: hypovascular (fewer blood vessels), hypocellular (fewer cells), and hypoxic (low oxygen). This model was described by Dr. Robert Marx and forms the basis for using HBOT in radiation injury treatment.
Tissue in this state can’t heal normally. It can’t fight infection well. Even minor trauma, like a dental extraction, can trigger breakdown that won’t recover on its own.
This is why late radiation effects can appear long after treatment ends. The tissue was damaged at the time of radiation. It just takes time for the consequences to surface.
Conditions HBOT Treats
Several specific conditions fall under radiation injury. HBOT is used for all of them.
Osteoradionecrosis (ORN) is bone death in tissue that received radiation. It most often affects the jaw (mandible) after head and neck radiation therapy. ORN can be debilitating, causing pain, infection, and significant loss of bone and function. Surgery is often required, and HBOT is used before and after to improve outcomes.
Soft tissue radionecrosis is dead or dying soft tissue in a previously irradiated area. It can occur in the head, neck, chest, or pelvis depending on where radiation was delivered.
Radiation proctitis and cystitis are injuries to the rectum or bladder after pelvic radiation. This type of radiation is common for prostate, cervical, and rectal cancers. Patients may experience chronic bleeding, pain, and urgency. HBOT reduces these symptoms by restoring blood flow to the damaged tissue.
Radiation-induced wound healing problems occur when wounds in previously irradiated tissue won’t close. This can happen after surgery in a field that was irradiated years earlier.
What the Research Shows
Two important studies form the evidence base for HBOT in radiation injury.
Annane et al. (2004) published a randomized controlled trial examining HBOT for osteoradionecrosis of the jaw. They found that HBOT improved outcomes compared to placebo in patients with established ORN. This is one of the few RCTs in this area. (PMID: 15611508)
Clarke et al. (2008) studied HBOT for chronic refractory radiation proctitis. Their findings showed significant reductions in rectal bleeding and improvement in quality of life after HBOT. Most patients in the study had failed other treatments. (PMID: 18330644)
Together, these studies support what many radiation oncologists and hyperbaric physicians observe clinically. HBOT helps restore function to tissue that radiation has compromised.
What Treatment Looks Like
Treatment protocols vary based on the specific condition.
For osteoradionecrosis, the Marx protocol is the clinical standard when surgery is needed. It involves 20 sessions of HBOT before surgery, followed by surgery to remove the necrotic bone, followed by 10 more sessions after surgery. The pre-op sessions help improve blood supply to the tissue. The post-op sessions support healing and reduce the risk of further breakdown.
For radiation proctitis and cystitis, treatment typically involves 30 to 40 sessions without surgery. The goal is symptom reduction and tissue repair.
For radiation-induced wound healing problems, protocols are similar to standard wound HBOT: typically 20 to 40 sessions at 2.0 to 2.4 ATA, each running 90 to 120 minutes.
You can find general information on session counts and what to expect in our HBOT cost guide and insurance guide.
Also see our conditions overview for other FDA-approved uses of HBOT.
Frequently Asked Questions
How long after radiation does injury appear?
Radiation injury can appear months to years after treatment ends. Osteoradionecrosis can emerge decades later, often triggered by a dental procedure or trauma to the jaw. If you’ve had head and neck radiation, tell your dentist before any dental work.
Can HBOT help with radiation proctitis?
Yes. Studies show HBOT reduces rectal bleeding and pain in patients with radiation proctitis after pelvic radiation therapy. It’s an FDA-approved indication. Most patients see improvement within 30 to 40 sessions.
Do I need surgery with HBOT for osteoradionecrosis?
For established ORN, surgery is often necessary to remove the dead bone. HBOT is used before and after surgery using the Marx protocol (20 sessions pre-op and 10 sessions post-op) to improve healing of the irradiated tissue.
Is this covered by insurance?
Medicare and most commercial insurers cover HBOT for radiation injury with proper diagnosis documentation. Your hyperbaric care team will help with the prior authorization process. See our insurance guide for details.
References:
- Annane D, et al. Hyperbaric oxygen therapy for radionecrosis of the jaw. J Clin Oncol. 2004;22(24):4893-900. PMID: 15611508.
- Clarke RE, et al. Hyperbaric oxygen treatment of chronic refractory radiation proctitis. Dis Colon Rectum. 2008;51(6):891-900. PMID: 18330644.
Medical Disclaimer: This page is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before pursuing any medical treatment.