Description

ABSTRACT

Feldmeier JJ, Gesell LB. Delayed Radiation Injuries (Soft Tissue and Bony Necrosis) and Potential for

Future Research. Undersea Hyperb Med. 2026 First Quarter; 53(1):155-198.

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.