Radionecrosis (delayed radiation injury)

Hyperbaric Oxygen Therapy Approval Status

Yes Clearance by US Food and Drug Administration (FDA)

Yes Approval by the Undersea and Hyperbaric Medical Society (UHMS)

About Clearance and Approval


Definition and Causes

Radionecrosis is a complication of cancer radiation therapy, especially external beam radiation therapy (EBRT). Necrosis means the death of cells in bones, organs, and soft tissues. Side effects of radiation therapy may not present a health problem for months or even years after treatment.

To irradiate a cancer tumor physicians and technicians always risk damaging nearby soft tissue and bone. Delayed radiation injuries most often stem from scarring and restricted blood flow near the tumor treatment site. The linings of blood vessels and the gastrointestinal tract are especially vulnerable to radiation damage. Radionecrosis may also be caused by radiation overdose or by misdirected beams of radiation, whether resulting from human error or from device malfunction.

Evidence Index

FDA cleared, widely reimbursed
Strong body of evidence
Repeatedly favorable results
Early or mixed results
Unfavorable or no evidence
Strong evidence against HBOT

Treatment with Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy (HBOT) is widely accepted as an effective treatment for delayed radiation injuries. HBOT works by improving blood circulation, supplying more oxygen to damaged tissue, reducing scarring, and increasing stem cell activity. Common treatment sites include the jaw, neck, and pelvis.

Important: Hyperbaric oxygen therapy is used to treat delayed radiation injuries, not for acute radiation injuries, acute radiation syndrome (ARS), or radiation poisoning.

Read the Delayed Radiation Injuries (Soft Tissue and Bony Necrosis) page in the Undersea and Hyperbaric Medical Society resource library to learn more about the mechanisms and efficacy of hyperbaric oxygen, clinical results, and future areas for research.

HyperbaricLink Commentary

Radionecrosis ranks among the most well-researched and common uses of hyperbaric oxygen therapy today. Medical science offers few other options for cancer patients who suffer delayed radiation injuries. As more oncologists employ more powerful and sophisticated radiation therapy technologies, more patients will be healed. And more will be hurt. So the lack of access to accredited hyperbaric facilities and certified hyperbaric physicians and technicians is public health deficiency.

Patient Resources

HyperbaricLink recommends the following websites for anyone seeking authoritative information, patient advocacy, and community support for radionecrosis and cancer.

American Cancer Society

The largest voluntary health organization in the US, with more than 900 local offices, the American Cancer Society is the leading source of cancer information, clinical research, community support, and advocacy for people affected by cancer.

Read the American Cancer Society section on Radiation Therapy.

Association of Cancer Online Resources (ACOR)

The Association of Cancer Online Resources is a social network, information resource, and e-mail list service for people affected by cancer. Established in 1995, the nonprofit ACOR is remarkable for its early use of the web to improve healthcare.


Internet home of the iconic yellow bracelet, LIVESTRONG is a popular source of information, advocacy, and inspiration for people affected by cancer.

Read the LIVESTRONG section on after effects of cancer treatment.

Wikipedia: Radiation therapy

The radiation therapy entry in Wikipedia provides good basic information about the different types and uses of radiation therapy.

Clinical Resources

Start with the following resources to explore current research activities and the peer-reviewed medical literature on hyperbaric oxygen therapy for radionecrosis.

 Use the search buttons below to go directly to research on hyperbaric oxygen therapy.

ACHM Radiation Research Registry (RRR)

Coordinated by the American College of Hyperbaric Medicine (ACHM), the RRR is a registry of clinical outcomes data on 2,500 radionecrosis patients treated with HBOT at hundreds of centers across the US.

Read the ACHM interim analysis and learn more about the RRR.
US National Institutes of Health keeps the official list of human clinical trials currently enrolling, in progress, and recently completed. One may reasonably question the size and legitimacy of any study not listed here.



An independent, international, nongovernmental organization, Cochrane is a powerful force in evidence-based medicine. One may consider a Cochrane Reviews article on any HBOT topic required hyperbaric reading.

Read the 2012 Cochrane Intervention Review: Hyperbaric oxygen therapy for late radiation tissue injury  from the Cochrane Gynaecological Cancer Group, doi:10.1002/14651858.CD005005.pub3

Google Scholar

A specialized Google search engine, Google Scholar indexes scholarly articles, patents, and legal opinions and journals. Google Scholar may produce many search results, but entries provide easy access to full-text journal articles.

Search Google Scholar


HBOEvidence uses computerized tools to appraise the key randomized controlled trials (RCTs) in the hyperbaric medical literature. One may reasonably question the overall strength of HBOT evidence for any disease or condition not covered here.

Search HBOEvidence
US National Library of Medicine, US National Institutes of Health

PubMed keeps the official list of scientific papers published in reputable peer-reviewed medical journals. One may reasonably question the importance and legitimacy of any study not listed here.



News About Radiation Injury and Hyperbaric Oxygen Therapy

More news from O2.0 – the HyperbaricLink blog

Complete radiation injury news archive from O2.0 — the HyperbaricLink blog

Further Reading

HyperbaricLink suggests the Radiation Boom series of investigative reports published 2010-2011 in the New York Times.

New York Times: Radiation Boom story illustration

Related Terms

  • Bony necrosis
  • Brachytherapy
  • Cancer
  • Cyberknife
  • External beam radiation therapy (EBRT)
  • Gamma Knife
  • Image-guided radiation therapy (IGRT)
  • Late radiation tissue injury (LRTI)
  • Linear partical accelerator (Linac)
  • Osteonecrosis
  • Radiation oncology
  • Radiation therapy
  • Radiotherapy
  • Soft tissue necrosis
  • Stereotactic radiosurgery (SRS)
Undersea and Hyperbaric Medical Society, Indications, Delayed Radiation Injury. Retrieved 02 May 2015.
American College of Hyperbaric Medicine, Soft Tissue Radionecrosis. Retrieved 11 Apr 2011.
Page Data
Updated: 27 Jul 2015 02:44 PM
Created: 13 Jun 2009 12:00 AM
By: About the authors »