Hyperbaric oxygen therapy reverses radiation damage and rebuilds tissue destroyed by cancer treatment
Understanding radiation injury and why tissues fail to heal after cancer treatment
Radiation therapy is an essential cancer treatment, but the ionizing radiation that destroys tumor cells also damages the small blood vessels (microvasculature) that nourish the surrounding normal tissue. Over time, this microvascular damage leads to progressive obliterative endarteritis — a gradual scarring and closing off of small vessels that leaves the irradiated tissue chronically hypoxic, fibrotic and unable to heal.
This explains a phenomenon that confuses many cancer survivors: wounds that will not heal, jaw bone that breaks down years after dental work, fistulas and necrotic tissue that appear long after radiation treatment ended. The tissue is not failing because of the original cancer — it is failing because it has lost the blood supply it needs to repair itself.
HBOT addresses this at the root cause. By raising plasma oxygen concentrations 10 to 15 times above normal through high-pressure breathing, HBOT drives oxygen into hypoxic tissue and triggers the growth of new blood vessels (angiogenesis). Over a treatment course, this neovascularization progressively restores perfusion and healing capacity to tissue that radiation had rendered permanently ischemic.
Jaw pain, exposed bone and non-healing wounds after dental procedures following head and neck radiation (osteoradionecrosis)
Chronic non-healing wounds, ulcers and tissue breakdown in previously irradiated fields
Rectal bleeding, pain and fistulas following pelvic radiation (radiation proctitis)
Bladder pain, bleeding and dysfunction after pelvic radiation (radiation cystitis)
Soft tissue fibrosis, pain and restricted movement in the irradiated area
Non-healing wounds following reconstructive surgery in a previously irradiated field
How HBOT reverses radiation injury
Radiation destroys the microvascular supply that keeps tissue alive and healing. HBOT is the only proven therapy that rebuilds that supply — restoring healing capacity to tissue that radiation left permanently ischemic.
Stimulates new blood vessel growth in irradiated tissue
Restores tissue oxygen to levels that support healing
Enhances the effectiveness of surgery in irradiated tissue
Reduces fibrosis and tissue hardening
Activates stem cells and tissue repair mechanisms
Treats bone and soft tissue simultaneously
For Providers
Clinical evidence for HBOT in radiation injury
HBOT for soft tissue radionecrosis and osteoradionecrosis is a Medicare-approved indication with robust clinical and mechanistic evidence spanning four decades.
Marx's landmark framework (1983): Dr. Robert Marx established the foundational scientific model for radiation injury and HBOT in two landmark publications. In Journal of Oral and Maxillofacial Surgery (1983), Marx demonstrated that osteoradionecrosis results from hypoxic-hypovascular-hypocellular tissue, and that HBOT restores the oxygen gradient necessary for angiogenesis and cellular repair. These papers remain the most-cited work in hyperbaric medicine. [Marx RE. J Oral Maxillofac Surg. 1983;41(5):283–288 and 41(6):351–357. PMID: 6576099]
Randomized controlled trial — ORN96 (2004): Annane et al. conducted a randomized, placebo-controlled, double-blind trial of HBOT for mandibular osteoradionecrosis (ORN) in the Journal of Clinical Oncology. The trial found significantly higher rates of mucosal coverage and bone exposure resolution in the HBOT group compared to placebo. [Annane D et al. J Clin Oncol. 2004;22(24):4893–4900. PMID: 15520062]
Soft tissue radionecrosis and surgical salvage: HBOT is established both as a primary treatment for radiation injury and as a perioperative adjunct when surgery is required in irradiated tissue. Studies consistently show that HBOT before and after surgery in irradiated fields significantly reduces wound breakdown, dehiscence and infection. Marx's prospective trial of 74 patients demonstrated that preoperative HBOT reduced complication rates in irradiated bone surgery from 29% to 5%. [Marx RE, Johnson RP, Kline SN. J Am Dent Assoc. 1985;111(2):219–224. PMID: 3862368]
Radiation proctitis and cystitis: Multiple controlled studies support HBOT for radiation-induced bowel and bladder injury. Clarke et al. demonstrated significant improvements in rectal bleeding, pain and quality of life in patients treated with HBOT for radiation proctitis. [Clarke RE et al. Dis Colon Rectum. 2008;51(4):516–523. PMID: 18157579]
UHMS approval: The Undersea and Hyperbaric Medical Society (UHMS) and Medicare recognize both soft tissue radionecrosis and osteoradionecrosis as approved indications for HBOT, reflecting the strength of the evidence base for this application.
Our treatment protocol for radiation injury at Bay Area Hyperbarics
Radiation injury treatment requires a sustained course of HBOT to achieve progressive neovascularization. We work closely with your oncology and surgical teams throughout your treatment.
Medical evaluation and oncology coordination
Our medical team reviews your radiation history, current wound or bone status, and imaging to confirm your case is appropriate for HBOT. We coordinate with your radiation oncologist and, where relevant, your oral surgeon or colorectal specialist to develop an integrated treatment plan.
Daily HBOT sessions to restore circulation and healing
You breathe 100% oxygen at 2.0 to 2.4 atmospheres absolute for approximately 90 minutes per session. Radiation injury typically requires 30 to 60 sessions depending on severity and tissue type involved. Sessions are scheduled once daily, five days per week.
Ongoing wound monitoring and surgical coordination
We monitor wound healing, bone viability and tissue response throughout treatment. If surgical intervention is required — such as debridement of necrotic bone or tissue — we coordinate pre- and post-operative HBOT to maximize surgical outcomes and reduce complications.
Frequently Asked Questions
Answers to the questions cancer survivors most often ask about hyperbaric oxygen therapy for radiation injury to bones and soft tissues.
Radiation injury can be treated with HBOT years or even decades after the original cancer treatment. The progressive vascular damage from radiation continues to evolve over time, and HBOT is effective at any point where viable tissue remains that can benefit from restored oxygenation. We have treated patients presenting 20 or more years after their original radiation course.
Most radiation injury protocols call for 30 to 60 sessions, depending on the severity and location of the injury. Osteoradionecrosis of the jaw typically requires 30 sessions before any surgical intervention and an additional 10 after. Soft tissue radionecrosis and conditions like radiation proctitis or cystitis may require 40 or more sessions. Our team will outline a specific protocol based on your case.
Yes. Medicare recognizes both soft tissue radionecrosis and osteoradionecrosis as approved indications for HBOT. Most major private insurers follow Medicare's coverage guidelines. Our staff will handle all prior authorization and coordinate with your insurer to ensure coverage is in place before treatment begins.
Yes — and this is one of the most important applications of HBOT in radiation injury. Surgery in previously irradiated tissue carries a very high risk of wound breakdown and healing failure. HBOT given before and after surgery significantly reduces these risks by restoring the blood supply to the surgical field before the incision is made. Marx's prospective trial showed this approach reduced surgical complication rates in irradiated bone from 29% to 5%.
Yes. Radiation proctitis (bowel damage) and radiation cystitis (bladder damage) following pelvic radiation for prostate, cervical, bladder or rectal cancers are both recognized applications of HBOT. Clinical trials have demonstrated significant reductions in rectal bleeding, pain and urinary symptoms following HBOT treatment.
This is the most common concern we hear from patients. The evidence strongly indicates that HBOT does not promote tumor growth or recurrence. A systematic review by Feldmeier et al. in Undersea and Hyperbaric Medicine (2003) examined this question extensively and found no evidence of tumor promotion. HBOT is treating the damage from your cancer treatment, not the cancer itself.
Dealing with radiation injury? Ask us about HBOT
Bay Area Hyperbarics specializes in HBOT for cancer survivors suffering from radiation damage to bone and soft tissue. Call us to find out whether your condition qualifies and how many sessions you may need.
