OTHER SITE TISSUE NECROSIS:
DELAYED RADIATION TREATMENT DAMAGE

    SPINAL CORD

    Spinal cord symptoms may be the result of late effect radiation damage, or they can result from recurrent or spreading tumor. Radiation damage is a function of total radiation exposure and frequency of treatment. Leg motor function can be impaired, typically 2 to 25 years after treatment.

    

In 5 reports of 17 patients treated with HBOT, 100% showed improvement for radiation-induced neuropathy, with long term improvement present in 85%. Fontanesi’s unpublished study showed a 90% positive response rate. It appears that HBOT may be the only treatment capable of reversing brain radiation-induced neuropathy.

    

Investigation of the use of HBOT to reduce radiation-induced inflammation in the central nervous system is still under study. It has been show to be an important therapy for radiation induced swelling and neuropathy within the brain, as an adjunct to surgery and the use of corticosteroids.

    CHEST

    Radiation treatment of chest and chest wall (most commonly lung and breast malignancies) often results in lung inflammation, pneumonia, and collapsed lung. Less common is actual tissue death, but lung cancer, and mesothelioma, a cancer of the tissue surrounding the lungs and most often seen in persons exposed to asbestos, may occur. Nerve damage to the larynx (voice box) or the diaphragm can also result from radiation treatment.

    Radiation-induced heart disease and arteriosclerosis are increasing in prevalence, as well as valve insufficiency, and muscle damage. Previous chemotherapy, total body irradiation, or concentrated administration adjacent to the heart or on the left side of the chest increase risks to the heart.

    

In 1992, The American Heart Association endorsed HBOT for heart attack, noting its ability to boost clot busting drugs, minimized heart damage, and save lives.

    

Study results for HBOT treatment were 75% resolution for soft tissue necrosis and 53% for bone necrosis, which included substantial healing after the removal of dead bone.

    

Post breast cancer radiation patients with persistent and intense pain experience significant relief with HBOT.

    ABDOMEN AND PELVIS

    The digestive tract and reproductive organs all carry similar organ-related risks, from immediate inflammation to a reduction in function. The reactions may be acute, but are often delayed and not visible until years later. Small bowel obstruction and adhesions (things sticking together that don’t belong stuck together), damage to the kidneys and ureters (drainage from the kidneys to the bladder), proctitis (inflammation of the rectum) and subsequent potential for chronic bleeding, fistulas (the development of abnormal ducts), stricture (the narrowing of body passages), and rectal ulcers may be treated by surgery. The results from bowel resectioning (rejoining to bypass defective tissue) or colostomy (connecting the bowel to an opening in abdominal wall) have been discouraging.

    Gynecological radiation can lead to accelerated arteriosclerosis, bladder, vaginal, and rectal damage, and potential leg amputations.
    

One study showed that 53% of abdominal radiation patients treated with Hyperbaric Oxygen Therapy (HBOT) showed immediate improvement, with 66% showing long term improvement or cure. Another study showed 87% of HBOT patients experiencing complete symptom resolution after abdominal and pelvic radiation-induced necrosis. A third study of HBOT showed 36% complete resolution and 60% with improvement after radiation treatment resulted in proctitis (rectal inflammation) and enteritis (small bowel inflammation). Whether the damage is to the abdominal wall, groin, perineum, vaginal, or pelvic bones, HBOT provides the potential for complete resolution of injuries.

    A rare complication of radiation treatment is hemorrhagic cystitis, where the blood vessels within the bladder swell and leak blood into the urine.
    

In a limited study of post-radiation bladder cancer patients, 30 of 40 patients who had severe urinary bleeding showed no blood in the urine after 20 HBOT sessions and 7 with occasional bleeding. Only 3 showed no change. Long term success (over 76% in another study) of HBOT for post-radiation bladder inflammation is impressive. Researchers also found that areas of the bladder that were resistant to HBOT quite frequently had tumor recurrence, so analyzing HBOT response was an effective way to determine the presence of diseased tissue.

    LIMB

    The extremities (arms and legs) may develop swelling long after radiation treatment. This is associated with damage to the lymph and circulatory systems, treatment-area specific scarring, and muscle atrophy.
    

Hyperbaric Oxygen Therapy (HBOT) has many of the same benefits for necrosis as it has for other wound-healing applications, reducing swelling and initiating and accelerating the growth of healthy tissue. In cases without recurrent cancer, up to 85% of treated patients had complete soft tissue necrosis resolution with HBOT.

    

For ulcers, HBOT stimulates collagen formation and enhances the development of new blood vessels into the previously oxygen-starved tissues, measurable after only 8 HBOT treatments. After 20 treatments, the development of new capillaries plateaus at 80 to 85% of that in unradiated tissue. HBOT has not shown benefits beyond the initial treatment.

    BONE

    Bone is almost twice as dense as soft tissues, and absorbs a larger amount of incident radiation than surrounding soft tissue. Radiation damages the bone cells, the ability of bone to build new white and red blood cells (a function of the marrow), and bone blood supply, as well as disrupting the constant normal process of bone resorption and building. When blood cell manufacture is disrupted, leukemia (blood or bone marrow cancer), hemorrhage (bleeding), or reduced resistance to infection can result. When more of the bone is destroyed than is built, the imbalance causes osteoporosis (thinning and weakening of the bones) and ultimately bone death (necrosis).

    Bone structures most frequently affected are:
         1) the lower jaw (because of its greater density and lesser blood supply) after head and neck radiation,
         2) the ribs, collar bone, and breastbone after breast cancer radiotherapy,
         3) the skull after treatment for brain and scalp tumors,
         4) the spinal column after radiation for spinal cord tumors, and
         5) the pelvis and head of the thigh bone following radiation of pelvic tumors.

    The incidence of secondary, radiation-induced cancers is decreasing due to the ability to provide more precise targeting and increased accuracy in choosing radiation dosage.
    

In the 1970s, the USAF developed an HBOT protocol for treatment of mandibular necrosis (death of the bone of the lower jaw), with an optimal sequencing of HBOT and surgery for per-surgical HBOT treatment. The success has been unparalleled. Subsequent studies showed a dramatic reduction in bone death when HBOT was used before dental extractions in highly at-risk patients.

    

In one study of radiation-induced lower jaw bone death, 83.6% of patients experienced significant improvement after HBOT.

    

When bone regeneration is required, an implant of healthy bone tissue may be needed to “jump start” healing.