Virginia Mason, Seattle, WA

Radiation Tissue Injury

Radiation injury to tissues (radionecrosis, radiation necrosis, osteoradionecrosis) is a complication or “side effect” of radiation therapy for a tumor. This occurs because the radiation can damage normal cells as well a tumor cells. Destruction of nutrient blood vessels in the irradiated area can result in local poor or non-healing wounds (ulceration), destruction of bone (necrosis) and bleeding.

Types of radiation injury

Radiation therapy for pelvic or abdominal tumors may result in bleeding or other symptoms. Bleeding from the bladder (radiation cystitis), small bowel (radiation enteritis) or rectum (radiation proctitis) are the most common complications. Symptoms of frequency, urgency, pain, incontinence and diarrhea may be experienced as well.

Radiation treatments for head and neck cancer can cause long term damage (necrosis) to the jaws, teeth and throat. Local non-healing wounds (ulceration) and decaying teeth (dental carries) are the most common side effects but may also include difficulty eating or swallowing, dry mouth or hoarseness.

Radiation of the chest for breast or lung cancer may result in soft tissue radionecrosis of the chest wall with symptoms of reduced range of motion or swelling of the lymph nodes.

Treatment with hyperbaric medicine

Hyperbaric oxygen (HBO2) is effective treatment for radiation tissue injury. Since the 1970s, surgeons of the head and neck region have come to recognize the value of hyperbaric oxygen treatments in treating radiation therapy damage of the jaw bone. Hyperbaric oxygen has had some of its most dramatic successes in treating or preventing damage to the jaw bone and is the treatment of choice for osteoradionecrosis. Hyperbaric oxygen therapy has also been used to treat radiation therapy damage of the brain, muscle and other soft tissues of the face and throat as well.

Virginia Mason Center for Hyperbaric Medicine patients are seen at the Seattle Main Clinic. In Virginia Mason’s extensive experience treating radiation injury to the bladder (cystitis), 82 percent of patients have improved. Among patients treated at Virginia Mason for injury to the bowel (enteritis) or rectum (proctitis), approximately 70 percent have shown improvement. No other treatment for radiation cystitis or radiation proctitis actually heals the injured tissue as well as hyperbaric oxygen therapy.

Surgery in a previously irradiated field may be accompanied by wound healing problems. When such surgery is performed, the addition of hyperbaric oxygen treatment may reduce wound breakdown, postoperative wound infections, and shorten healing times.

Decisions to manage chronic radiation tissue injury with hyperbaric oxygen therapy should be made by your managing physician, in consultation with an experienced hyperbaric physician.

How it all works

While cancer specialists would irradiate only cancer cells if they could, healthy cells are unavoidably affected. Cells that have a high rate of growth, such as those in the bowel, bladder, mouth and throat, are more sensitive to radiation damage. While acutely damaged cells have enough repair abilities to return to normal, the chronic condition shows radiation caused scarring and narrowing of the blood vessels resulting in poor blood supply. If this process progresses to the point that the normal tissues are no longer receiving an adequate blood supply, death or necrosis of these tissues can occur.

Hyperbaric oxygen uses high concentrations of oxygen to repair the damaged vessels and tissues. The air we breathe contains 21 percent oxygen. This can be increased to 100 percent if oxygen is breathed via a mask or hood (personalized oxygen tent surrounding your head). The body’s oxygen supply can be increased by a further two or three times by entering a hyperbaric chamber and receiving 100 percent oxygen at increased pressure. Oxygen administered in this manner is dissolved in the blood stream and delivered to body tissues at a far greater concentration. This high dose of oxygen is carried in the patient’s circulation to the site of injury to assist in the repair of not only the damage tissue but also to the damaged blood vessels as well.

During HBO2 therapy for radiation tissue injury, oxygen is administered as a series of 30 to 40 treatments. For long-lasting results, the entire series of treatments must be completed. These treatments take about two hours and are delivered once or twice daily.

The benefits to you include:

• Increasing oxygen promotes tiny new blood vessels to grow inside and around the radiation site. As you grow more blood vessels, more oxygen rich blood is able to reach the affected area.
• Decrease of swelling (edema) around the radiation site. Decreasing the swelling allows the blood to flow more freely to the area, bringing with it oxygen.
• High oxygen levels increases the ability of the ‘infection fighting’ cells (white blood cells) to kill bacteria.

See full article here.

Hyperbaric oxygen therapy for radiation induced proctopathy in men treated for prostate cancer

Marc A Dall’Era 1, Neil B Hampson, R Alex Hsi, Berit Madsen, John M CormanAffiliations expand

Abstract

Purpose: Radiation proctitis is a common complication following external beam radiation therapy and brachytherapy for prostate cancer. While 95% percent of radiation induced proctitis is temporary and self-limiting, up to 5% of patients experience toxicities that are refractory to conservative management. Hyperbaric oxygen has a well-defined role in treating chronic wounds, osteomyelitis, hemorrhagic cystitis and necrotizing fasciitis. We reviewed our experience with hyperbaric oxygen therapy for radiation induced proctitis in patients undergoing radiation treatment for prostate cancer.

Materials and methods: From October 1998 to December 2003, 27 patients with radiation induced proctitis secondary to brachytherapy (4), external beam radiation therapy (16) or combined modality (7) for prostate cancer were treated with hyperbaric oxygen therapy at Virginia Mason Medical Center in Seattle, Washington. In all patients primary medical or endoscopic management had failed. Patients received 100% oxygen in a multiplace hyperbaric chamber at a pressure of 2.4 atmospheres absolute for 90 minutes 5 to 7 days weekly for an average of 36 sessions (range 29 to 60). Data were collected from a retrospective review of medical records following approval by the Institutional Review Board at Virginia Mason Medical Center.

Results: All 27 men completed the planned course of therapy. Of patients with bleeding 48% showed complete resolution after therapy, while 28% reported significantly fewer bleeding episodes. Of patients 50% noted complete resolution of fecal urgency. Six of the 8 patients (75%) with pain noticed some improvement after therapy, although no patients reported complete resolution of rectal pain. Of patients with rectal ulceration 21% showed complete resolution of the ulcer on posttreatment endoscopy, while 29% showed evidence of improvement. Six patients (43%) had no change or worsening of rectal ulcers. Overall 67% of patients had a partial to good response, while 33% showed no response or disease progression.

Conclusions: This series of patients showed a good overall response rate to hyperbaric oxygen for radiation induced proctopathy after other attempts at management had failed. Hyperbaric oxygen is generally well tolerated and it remains an important treatment option for managing this common and difficult disease.

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Hyperbaric oxygen treatment reverses radiation induced pro-fibrotic and oxidative stress responses in a rat model

N Oscarsson 1, L Ny 2, J Mölne 3, F Lind 4, S-E Ricksten 5, H Seeman-Lodding 5, D Giglio

Abstract

Purpose: Radiotherapy is effective in the treatment of tumors in the pelvic area but is associated with side effects such as cystitis and proctitis. Hyperbaric Oxygen Therapy (HBOT) has emerged as a treatment modality for radiation-induced side effects. In a rat model for radiation cystitis, we studied the effects of HBOT on oxidative stress and pro-fibrotic factors.

Materials and methods: Sedated Sprague-Dawley rats underwent bladder irradiation of 20Gy with and without 20 sessions of HBOT during a fortnight. Control animals were treated with and without HBOT. All four groups of animals were euthanized 28 days later. Histopathological examinations, immunohistochemistry and quantitative polymerase chain reaction (qPCR) were used to analyze changes in oxidative stress (8-OHdG), anti-oxidative responses (SOD-1, SOD2, HO-1 and NRFα) and a panel of Th1-type and Th2-type cytokines (IL-1β, IL-4, IL-5, IL-6, IL-10, IL-13, TNF-α, TGF-β, IFN-γ) in the urinary bladder.

Results: Bladder irradiation increased the expression of 8-OHdG, SOD2, HO-1, NRFα, IL-10, TNF-α and tended to increase TGF-β. These changes were completely reversed by HBOT while HBOT in control animals had no effects on the studied markers for oxidative stress, anti-oxidative responses and Th1-type and Th2-type cytokines.

Conclusions: Radiation induced a significant elevation of oxidative stress, antioxidants and pro-fibrotic factors in our animal model for radiation cystitis that were completely reversed and normalized by HBOT. Our findings indicate that HBOT may prevent radiation-induced changes by affecting oxidative stress and inflammatory cascades induced by radiation.

Summary: Radiotherapy may cause the development of chronic inflammation and fibrosis, significantly impairing organ function. We hypothesized that bladder irradiation induces an oxidative stress reaction, thereby triggering the redox system and thus initiating an inflammatory and pro-fibrotic response. We aimed to assess whether these changes would be reversed by hyperbaric oxygen using an animal model for radiation cystitis. Our study show that hyperbaric oxygen therapy may reverse oxidative stress and pro-inflammatory factors induced by radiation.

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