Hyperbaric Oxygen Therapy for Delayed Radiation Injury

Radiation injury looks different depending on where radiation was given. Your physician determines whether HBOT is appropriate after reviewing your cancer history, radiation dose and site, current symptoms and the plans of your other doctors. These are the situations where HBOT is most often considered.

Osteoradionecrosis of the jaw

Osteoradionecrosis (ORN) means irradiated bone has died and become exposed, commonly in the lower jaw after radiation for head and neck cancer. It is generally defined as exposed bone in a radiation field that fails to heal over about three months. Symptoms can include pain, exposed bone in the mouth, drainage, trouble chewing or, in advanced cases, a fracture.

HBOT is used as an adjunct for established ORN, alongside care from an oral surgeon or head and neck surgeon. That care may include removing dead bone, antibiotics and, for advanced disease, reconstructive surgery. Medicare covers HBOT for osteoradionecrosis as an adjunct to conventional treatment. ORN can overlap with chronic bone infection.

Before and after tooth extraction in an irradiated jaw

People who have had high-dose radiation to the jaw are at risk of ORN after a tooth is pulled or an implant is placed. For decades, many dentists and oral surgeons have used the Marx protocol to try to lower that risk: 20 HBOT sessions before the extraction and 10 sessions after, each at 2.4 ATA for 90 minutes.

The evidence here has changed, and you deserve to know both sides. In 2019, the HOPON randomized trial found that ORN developed within six months in 6.4% of patients who received HBOT and 5.7% of those who did not. In other words, it found no benefit from preventive HBOT for extractions or implants in the irradiated lower jaw. The Marx protocol is still widely used, especially for heavily irradiated jaws, and HBOT remains a recognized adjunct for established ORN. Today, preventive HBOT before an extraction is a case-by-case decision. Your oral surgeon and our physician weigh your radiation dose, the site of the tooth and your history together.

If you do go ahead, timing matters, because the sessions before the extraction need to be scheduled around your dental appointment.

Radiation cystitis

Radiation cystitis is bladder damage after pelvic radiation, for example for prostate, cervical, uterine or rectal cancer. It can cause blood in the urine, urgency, frequent urination and pain. HBOT is used for chronic radiation cystitis alongside care from a urologist. A randomized trial called RICH-ART, described below, reported greater improvement in urinary symptoms with HBOT than with standard care.

Heavy bleeding with clots or an inability to urinate is an emergency. Go to an emergency room. HBOT is a course of treatment over weeks, not emergency care.

Radiation proctitis

Radiation proctitis is damage to the rectum after pelvic radiation. It can cause rectal bleeding, pain, urgency and mucus. It falls within the soft-tissue radionecrosis category, and HBOT may be considered when symptoms continue despite care from a gastroenterologist or colorectal surgeon. The evidence for proctitis comes from a smaller number of trials than for cystitis.

Soft-tissue injury after breast, head and neck or other radiation

Delayed radiation injury can also show up as skin or tissue that breaks down in an old radiation field, a surgical wound that won't heal in irradiated skin, or tissue damage in the throat or voice box after head and neck radiation. Surgery in irradiated tissue can be difficult, and some patients are evaluated for HBOT before or after reconstruction, including compromised flaps after reconstruction. These situations are assessed case by case. For wounds in general, see non-healing wounds.

If you are living with any of these problems, call (369) 222-0979 and ask whether HBOT fits your recovery plan.

At Generations Wellness, care is directed by Dr. Rajwinder Singh Bahia, MD. Sessions take place in hard-shell monoplace chambers, each for one person, where you breathe medical-grade oxygen at a physician-prescribed pressure.

• Number of sessions: commonly 30 to 40 for established radiation injury. The RICH-ART trial used 30 to 40. The Marx dental protocol uses 20 before and 10 after extraction.
• Pressure and length: commonly 2.0 to 2.4 ATA, with about 90 minutes of oxygen breathing plus pressurization and depressurization time.
• Frequency: usually once a day, five days a week, so a course takes six to eight weeks.
• Timing: HBOT is used for delayed injury that appears after radiation therapy is complete, not during active radiation treatment. Your oncologist and our physician decide timing together.
• Coordination: with your permission, we keep your oncologist, urologist, gastroenterologist, dentist or oral surgeon informed.

To picture a typical visit, read about your first session.

Does oxygen "feed" cancer?

Many cancer survivors worry about this, and it is a fair question. Research reviews have looked at whether HBOT promotes tumor growth or makes cancer more likely to return. A 2012 review in Targeted Oncology (Moen and Stuhr) concluded there is no evidence that HBOT stimulates tumor growth or increases recurrence. Even so, your cancer history matters. We ask about your current cancer status and, with your permission, coordinate with your oncologist before any course begins. HBOT here is used for radiation injury, not as a cancer treatment.

Generations Wellness currently offers HBOT on a self-pay basis. We do not bill insurance, Medicare or Medi-Cal today while we work toward insurance contracts, and we say so plainly before you begin.

In general, radiation injury is one of the indications insurance may cover. Original Medicare's NCD 20.29 covers osteoradionecrosis and soft-tissue radionecrosis as an adjunct to conventional treatment. At facilities that bill Medicare, patients typically pay the Part B deductible ($283 in 2026) and then 20% coinsurance, which published estimates put at roughly $90 to $115 per session. Commercial and Medicare Advantage plans commonly require prior authorization. Coverage for preventive dental HBOT varies more between plans.

Published national self-pay ranges for medical-grade HBOT at independent centers run about $150 to $450 per session. Because radiation injury courses are often 30 to 40 sessions, the course total matters most. These are ranges, not quotes. We review pricing for your physician-recommended plan clearly at your consultation. If you likely qualify for coverage, ask us and we'll explain your options honestly, including when another setting may make more financial sense. Learn more about Medicare coverage for osteoradionecrosis and the cost of a 30–40-session course.