Dr. James Fenno
James Fenno, MD





Hyperbaric Oxygen Treatment
for Late Effect Radiation Injury

James Fenno, MD
Hyperbaric Medicine & Wound Care
OakLeaf Advanced Wound Care &
Hyperbaric Medicine Center
Eau Claire

Cancer is a terrible thing. It is both mentally and physically taxing. Although modern medicine has many different and often successful treatments for cancer, some of these treatments can cause significant side effects such as nausea, anemia and tissue damage.

Radiation therapy for cancer treatment can cause several side effects or complications.
The term “late effect radiation injury” refers to any of a number of problems radiation therapy can cause.

Hyperbaric oxygen therapy, HBOT, can be used in some cases to reverse these problems allowing the surrounding tissues to heal or to prevent or minimize the chance of developing these problems.

An HBOT treatment or “dive” involves placing the patient in a hyperbaric chamber and pressurizing it with 100% oxygen at varying pressure depending on the condition being treated.

Osteoradionecrosis or ORN is a condition which causes bone to erode or dissolve away in areas which have previously received radiation therapy. The jawbone is a common place to see this occur. The radiation damages the arteries and the blood supply to the bone affecting its ability to heal properly. Seemingly minor trauma to the bone from an injury, tooth extraction or even irritation from wearing dentures can cause the jaw bone to begin to dissolve. Ultimately this causes the bone to die and be reabsorbed. Symptoms of ORN may include pain, swelling, an inability to open the mouth normally, exposed bone, spontaneous fractures of the affected bone, poor alignment of the teeth and jaw and possible development of a fistula (an abnormal connection between the inside of the mouth and the outside of the face).

Hyperbaric oxygen therapy (HBOT)

Common treatment of ORN may involve hyperbaric oxygen therapy, surgery, or a combination of both HBOT and surgery. Tissue or bone which has died is removed surgically. Bone grafting may help to speed recovery by filling the void left by the degraded bone (figure 2). HBOT helps the body to form new blood vessels in the area, stimulates tissue growth and elevates oxygen levels in the affected tissues. HBOT therapy for ORN would be expected to involve at least 30 “dives”, but may take up to 60 to achieve the maximal benefit.

Preventative treatment with HBOT prior to dental extraction or dental implants being placed can reduce the likelihood of the development of ORN once an area has been exposed to radiation therapy. A common protocol for this type of treatment would be 30 “dives” prior to any procedure, then 10 more HBOT treatments after the procedure is complete.

Radiation proctitis is a condition in which the tissues of the rectum and colon become inflamed in reaction to radiation therapy. It is most often seen after radiation treatment for cervical, prostate or colon cancer. Ionizing radiation from cancer therapy interacts with body fluids to create free radicals which are reactive compounds which interfere with DNA synthesis causing local tissues to weaken and sometimes die. This can cause bleeding, pain, chronic diarrhea, and sometimes abnormal connections between the colon and other structures such as the bladder (fistula).

There are two forms of radiation induced proctitis, acute (early) and chronic. Acute injury is seen usually within a month and a half after radiation therapy. Symptoms include diarrhea, the feeling of having to have a bowel movement and pain with attempted defecation. The chronic form may not appear until almost a year after the radiation therapy and can cause ongoing symptoms for many years if left untreated.

Hyperbaric oxygen therapy (HBOT)

Hyperbaric oxygen therapy can improve the body’s healing response reducing the risk of continued radiation proctitis and increasing bowel-specific quality of life. It works by a similar mechanism as with ORN, increasing new blood vessel growth, increasing oxygen levels in the affected tissues and stimulating tissues healing response. Typical HBOT treatments for radiation proctitis or colitis involves anywhere between 30 to 60 “dives” depending on the body’s response to the therapy.

Radiation cystitis is similar to radiation proctitis in that the tissues around the area which received radiation therapy become inflamed. Injury to the bladder from radiation therapy can cause irritation, blood in the urine, scarring and contracture, incontinence, fistula formation or death of previously normal tissue. This can cause permanent difficulties with urination.

The frequency of radiation cystitis (more than one year after treatment) based on common tumor sites are:

HBOT can be used for treatment of radiation cystitis as well. The hyperbaric oxygen works in the same manner as it does for radiation induced proctitis, increasing the oxygen levels in the affected tissues which induces new blood vessel development and stimulates affected tissues to begin healing. It is common for patients suffering from radiation cystitis to undergo between 30 to 60 HBOT “dives” to achieve maximal benefit.

Dr. James Fenno – OakLeaf Advanced Wound Care &
Hyperbaric Medicine Center
For information or to schedule an appointment:
715.839.6869 | www.oakleafsurgical.com/wound.php
Dr. Fenno sees patients in Eau Claire.