In what scenarios should I consider hyperbaric oxygen therapy for patients with radiation injuries?

Consider hyperbaric oxygen therapy (HBOT) for patients with radiation-induced injuries primarily in clinical scenarios involving chronic, non-healing wounds or tissue damage refractory to conventional treatments, such as radiation-induced soft tissue necrosis, osteoradionecrosis, and severe radiation-induced dermatitis that significantly impairs healing and quality of life. HBOT enhances oxygen delivery to hypoxic tissues, promoting angiogenesis and tissue repair, which can be particularly beneficial in these contexts. Specifically, in radiation-induced dermatitis, recent evidence from a randomized pilot study in breast cancer patients suggests HBOT may improve healing and symptom control when standard care is insufficient Lee et al. 2025. UK clinical guidelines support the use of HBOT in managing complex radiation injuries, especially where there is evidence of tissue hypoxia and necrosis, such as osteoradionecrosis of the jaw or refractory soft tissue radionecrosis, aligning with the pathophysiological rationale and emerging clinical data NICE NG36. Therefore, HBOT should be considered as an adjunctive therapy in patients with persistent radiation-induced tissue damage unresponsive to standard wound care and medical management, with multidisciplinary assessment to evaluate suitability and monitor for potential risks NICE NG36 Lee et al. 2025.