Delayed Radiation Injuries (Soft Tissue and Bony Necrosis) and Potential for Future Research

The application of hyperbaric oxygen (HBO₂) to the treatment and prevention of late radiation injury (LRTI) is the focus for this chapter. Additional miscellaneous topics related to radiation exposure and HBO₂ will also be explored, including areas of interest for research. We will also discuss some of the pertinent literature demonstrating the safety of HBO₂ for the cancer patient. A review of billing records from CMS demonstrates that delayed radiation injuries continue to be the most frequent indication for hyperbaric treatments in the United States, constituting about 40% of all their billings [1]. Hyperbaric oxygen should not be the sole treatment modality for many cases of radiation injury. The management of delayed radiation injury, especially when bone is involved, will likely require a multi-disciplinary approach. Importantly, each aspect of treatment including surgical technique must be optimized to give the best chance for a successful therapeutic effort. For radiation injuries, surgical intervention may require tissue flaps and skin grafts to compensate for tissues lost due to frank necrosis or previous cancer surgery. Free flap procedures employing microsurgical vascular anastomoses are being employed more and more often when done in radiated fields. Hyperbaric oxygen is still of benefit here. In the pages that follow, the etiology of delayed radiation injury, the specific mechanisms whereby HBO₂ is effective, positive clinical results, the effects of HBO₂ on cancer growth and potential areas for research will be reviewed. Publications reporting negative results for HBO₂ in the treatment of LRTI will also be analyzed and any errors, questionable methodologies in study design, or other shortcomings including inadequate HBO₂ protocols will be noted and explained.