HBOT Management for Radiation Necrosis

Overview

There is no satisfactory management for radiation necrosis, as it is difficult to deliver adequate nutrients and oxygen to the de-vascularized tissues. HBOT, through raising the oxygen tension within the soft tissues to the normal range, stimulates collagen formation at the burn margins. Enhancement of the microvasculature supplying the affected area occurs, resulting in improvement in the healing process in the affected region. This angiogenesis is measurable after 8 managements with HBOT. The rationale for non-healing wounds also applies to radiation necrosis. HBOT is not advised in the early post-radiation period since the potentiation of the effects of radiation may occur.

A minimum of 30 managements is needed. Mandibular osteonecrosis following radiation for head-and-neck tumors has been reported in some series to occur in as much as 62% of cases. The incidence may be decreased with HBOT.

Post-Radiation Myelitis:

The best outcome has been prophylactic radiation 6 weeks after radiation.

Radiation Encephalopathy:

This is best treated with vasodilators and HBOT. It requires at least 20-30 sessions for 90 minutes each. Others have used 40 sessions in cycles of 10.

Radiation-induced Optic Neuropathy:

Good results have been obtained with HBOT plus steroids and high doses of antioxidants.

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Radiation Necrosis Management

Prophylactic HBOT would be useful in the following conditions that may be associated with changes that occur following radiation:

  • delayed injury to extremities
  • soft tissue necrosis of head and neck
  • delayed injury to abdomen and pelvis
  • minimizing chances of hemorrhagic cystitis
  • Radiation proctitis

HBOT also has a tumor repressive effect.

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