Delayed radiation complications are typically seen six months or more after therapeutic radiation therapy. However, they can develop many years later. These complications result from scarring and narrowing of the blood vessels.
Since April 1st 2013, NHS England now regularly funds Hyperbaric Oxygen Therapy for the following elective conditions:
- Late radiation tissue injury
- Treatment and prophylaxis of osteoradionecrosis.
- Treatment and prophylaxis of radionecrosis of soft tissue.
Hyperbaric oxygen is the only treatment that has been shown in clinical trials to reverse the damaging affects of radiation. It has been used successfully for years in the treatment of these injuries. This therapy causes more oxygen to reach these damaged areas. This allows the tissue to grow new blood vessels and heal.
Radiation damage can occur anywhere in the body. Hyperbaric therapy is often used in patients who have had radiation to the head and neck area. This is to either to heal a wound or in anticipation of dental extractions. This helps to prevent serious complications that can occur when surgery is performed in an area which has been radiated.
Similar radiation damage can occur anywhere in the body that radiotherapy has been used to fight cancer. Radiation to the urinary bladder can cause pain and bleeding, and is called hemorrhagic cystitis. Radiation proctitis can occur when there is radiation to the area of the bowels. This can cause bleeding, pain, diarrhea and in some instances a fistula. This is a small hole in the bowel which can not heal. Any area of soft tissue (skin or muscle) or bone that has radiation related injury may benefit from hyperbaric therapy. There is also new evidence to support the use of hyperbaric therapy in patients with side effects from brain radiation.
Radiation proctitis is a common unfortunate complication of radiation to lower abdomen and pelvis. It most commonly occurs after radiation treatment for cancers such as cervical cancer, prostate cancer, and colon cancer. Radiation proctitis involves the lower intestine, primarily the sigmoid colon and the rectum.
Radiation treatment: This is a treatment that uses x-rays or gamma rays to treat cancer. Having this done on your pelvic (hip) area may damage your rectal tissues and blood vessels, causing proctitis. Proctitis caused by radiation may occur for a period of three months after your treatment. Chronic radiation proctitis (CRP) may occur months or years after your treatment.
Clinical features: Early symptoms can develop during the first or second week of radiation therapy. Nausea, and vomiting are seen with upper abdominal radiation therapy as opposed with pelvic radiation. Involvement of small intestine leads to abdominal cramps, nausea, and watery diarrhoea. Large intestinal irradiation leads to diarrhoea, tenesmus, mucoid rectal discharge, and rectal bleeding if ulceration is present. However, many patients remain symptom free even with mucosal ulceration.
The late symptoms appear at an interval range of 3 months to 30(??10 ) years. The most common symptom with small intestinal radiation damage is colicky abdominal pain,nausea, vomiting, and small intestinal obstruction can also occur. If the ileum is extensively involved, malabsorption may be prominent. Patients with chronic radiation injury of rectum will have symptoms of proctitis, including tenesmus, mucoid rectal discharge, bleeding from rectum, constipation , loss of sphincter control and rarely fistulous tract into adjacent organs or bowel obstruction.
Treatment: High failure rates with conventional Treatment led to the use of HBO therapy, which has been shown in clinical trials to reverse the damaging effects of radiation. Chronic radiation complications result from scarring and narrowing of blood vessels within the area, which received the treatment. This therapy causes more oxygen to reach these damaged areas allowing tissue to grow new blood vessels and heal . It has been used successfully for years in the treatment of these injuries and others such as radiation enteritis and radiation cystitis.
1.Hyperbaric Oxygen Treatment of chronic refractory radiation proctitis: randomised and controlled double-blind crossover trial with long-term follow-up.-R.Clarke Int.J. RADIATION oncology Bio.Phys., pp 1-10 ,2008
2.Hyperbaric Oxygen Therapy for late radiation tissue injury (review)-Bennett MH, Feldmeier J. Cochrane Database of systematic reviews 2005, Issue 3