TLDR

Radiation therapy saves lives — but it also damages the tissue it passes through, sometimes years after treatment ends. Hyperbaric Oxygen Therapy (HBOT) is FDA-approved and covered by Medicare and most PPO insurance plans for delayed radiation injuries including osteoradionecrosis (ORN), radiation cystitis, soft tissue radionecrosis (STNR), and radiation proctitis. At OxygenWell in Sherman Oaks and Calabasas, we treat radiation-injured patients using the Marx Protocol — the gold standard for HBOT in radiation injury care.

Table of Contents

• What Is Radiation-Induced Tissue Injury?
• Radiation Injury Conditions Treated with HBOT
• How HBOT Repairs Radiation Damage
• Clinical Evidence and PubMed Research
• The Marx Protocol: HBOT Before and After Dental Procedures
• Who Qualifies for Insurance-Covered HBOT?
• OxygenWell's Radiation Injury Protocol
• Frequently Asked Questions

What Is Radiation-Induced Tissue Injury?

Radiation therapy is a cornerstone of cancer treatment — effective at targeting tumors, but unavoidably damaging to surrounding healthy tissue. The damage occurs in two phases:

• Acute effects: Inflammation, skin reactions, and mucositis during or immediately after treatment
• Delayed effects: Progressive vascular damage, tissue hypoxia, and fibrosis that develop months or years after radiation ends

The delayed effects are often the more serious problem. Radiation causes radiation-induced obliterative endarteritis — a progressive destruction of the small blood vessels in irradiated tissue. Over time, this creates a hypoxic, hypovascular, hypocellular wound environment: tissues that are oxygen-starved, poorly vascularized, and unable to heal. This is the pathological basis for ORN, radiation cystitis, and STNR.

Radiation Injury Conditions Treated with HBOT

Osteoradionecrosis (ORN)

Osteoradionecrosis is the death of bone tissue due to radiation damage. It most commonly occurs in the jaw (mandibular ORN) after head and neck radiation — particularly following dental extractions in previously irradiated tissue. ORN presents as exposed, non-healing bone that refuses to repair because the underlying vasculature has been destroyed by radiation.

Radiation Cystitis

Radiation cystitis is bladder damage caused by pelvic radiation — most commonly in patients treated for prostate, bladder, cervical, or colorectal cancer. Symptoms include pelvic pain, urinary urgency, frequency, hematuria, and in severe cases, hemorrhagic cystitis with significant bleeding. HBOT addresses the underlying vascular damage and promotes regeneration of the bladder lining, with resolution of hemorrhage reported in 76–88% of patients.

Soft Tissue Radionecrosis (STNR)

Soft tissue radionecrosis refers to the progressive death of non-bony soft tissue in the radiation field. It can affect breast tissue, chest wall, or abdominal tissue — presenting as non-healing wounds, tissue breakdown, and chronic ulceration.

Radiation Proctitis

Radiation proctitis is damage to the rectum from pelvic radiation, causing rectal bleeding, pain, urgency, and in chronic cases, fistula formation. HBOT is effective for chronic hemorrhagic radiation proctitis that has not responded to conventional management.

Mandibular ORN: Pre and Post Dental Extractions (Marx Protocol)

Patients who have received head and neck radiation face significant risk of ORN following dental procedures. The Marx Protocol — 20 HBOT sessions before and 10 after dental extraction — reduces this risk from nearly 30% to under 6%.

How HBOT Repairs Radiation Damage

1. Angiogenesis — Rebuilding the Vascular Supply

HBOT stimulates VEGF release and mobilizes CD34+ endothelial progenitor stem cells, triggering the growth of new blood vessels into radiation-damaged tissue. This is the single most important mechanism by which HBOT reverses delayed radiation injury. [Thom SR, J Appl Physiol. 2011]

2. Hyperoxygenation of Hypoxic Tissue

At 2.0–2.4 ATA, HBOT dissolves oxygen directly into plasma, delivering it to tissues that irradiated blood vessels can no longer supply. This restores the tissue oxygen tension required for fibroblast activity, collagen synthesis, and immune function. [Hopf HW et al., Wound Repair Regen. 2004]

3. Reversal of Radiation Fibrosis

HBOT down-regulates TGF-β1 — the key cytokine responsible for radiation-induced fibrosis — reducing scar tissue formation and softening fibrotic tissue in the radiation field. [Marx RE et al., J Oral Maxillofac Surg. 1990]

Clinical Evidence and PubMed Research

ORN Incidence Reduced from 29.9% to 5.4%

The landmark Marx Protocol study demonstrated that perioperative HBOT reduced the incidence of osteoradionecrosis following dental extraction from 29.9% in the control group to 5.4% — a greater than 80% reduction. [Marx RE et al., JADA. 1985]

Radiation Cystitis: 76–88% Resolution of Hemorrhage

A systematic review of HBOT for radiation cystitis reported complete or significant resolution of hematuria in 76–88% of patients, with best outcomes in patients who began HBOT before irreversible bladder contracture. [Bevers RF et al., Eur Urol. 1995]

Soft Tissue Radionecrosis

A review published in StatPearls (NCBI, 2023) confirmed HBOT as an effective adjunct for STNR, reporting significant improvements in wound healing, reduction in wound size, and patient quality of life. [Thom SR & Bhopale VM, StatPearls. 2023]

Radiation Proctitis: 89% Resolution of Rectal Bleeding

A prospective study of HBOT for chronic hemorrhagic radiation proctitis reported that 89% of patients achieved complete resolution of rectal bleeding after an HBOT course, with durable results at long-term follow-up. [Clarke RE et al., Dis Colon Rectum. 1996]

The Marx Protocol: HBOT Before and After Dental Procedures

For head and neck cancer survivors who have received jaw radiation and require dental extractions, oral surgery, or dental implants, the Marx Protocol is the standard of care for ORN prevention:

• Before dental procedure: 20 HBOT sessions at 2.0–2.4 ATA, 90 minutes each
• After dental procedure: 10 HBOT sessions at 2.0–2.4 ATA, 90 minutes each

OxygenWell works directly with oral surgeons, dentists, and oncologists to coordinate this perioperative protocol.

Who Qualifies for Insurance-Covered HBOT?

The following conditions are FDA-approved and covered by Medicare and most PPO plans:

• Osteoradionecrosis (ORN)
• Radiation cystitis
• Soft tissue radionecrosis (STNR)
• Radiation proctitis
• Mandibular ORN: pre and post dental extractions (Marx Protocol)

A physician referral is required. Verify your coverage at oxygenwell.com.

OxygenWell's Radiation Injury Protocol

OxygenWell is a physician-owned HBOT center in Sherman Oaks and Calabasas, CA, founded and led by Dr. Beth Meneley, DAOM, L.Ac. With 25+ years in integrative medicine and 12+ years dedicated to hyperbaric medicine in Los Angeles, our team has delivered over 50,000 HBOT sessions.

• Pressure: 2.0–2.4 ATA
• Session length: 90 minutes
• Frequency: 5 days per week
• Total sessions: 20–40+ depending on condition and response
• Oxygen: 100% medical-grade, high-flow delivery (not a concentrator)

For Active Cancer Patients

• Before radiation: 1.5–2.0 ATA, 60–90 min, 2–5x per week
• During radiation: 1.5 ATA, 60–90 min, 2–5x per week as tolerated
• After radiation (delayed injury): 2.0–2.4 ATA, 90 min, 5x per week, 20–40+ sessions

Current evidence does not show HBOT promotes cancer growth. All protocols are coordinated with the patient's oncology team.

Frequently Asked Questions

How soon after radiation can HBOT begin?

HBOT can begin at any point after radiation ends — even years later. Earlier treatment produces better outcomes, as HBOT is most effective before extensive fibrosis develops. For the Marx Protocol, HBOT begins 2–4 weeks before the planned dental procedure.

Is HBOT safe for cancer survivors?

Yes. Current peer-reviewed evidence does not show HBOT promotes tumor recurrence. It is an adjunct to conventional cancer care, not a replacement. All cancer patients receive individualized protocols reviewed by our medical team and coordinated with their oncologist.

How many sessions to see improvement?

Radiation cystitis patients typically notice symptom reduction within 10–20 sessions. ORN and STNR require 30–40 sessions for measurable tissue response. The Marx Protocol is a defined 30-session perioperative course.

Is HBOT covered by insurance for radiation injuries?

Yes. Delayed radiation injuries are among the most clearly covered HBOT indications under Medicare and most PPO plans. Call OxygenWell at (818) 661-0939 to verify your coverage.

Schedule a Consultation at OxygenWell

If you or a patient is experiencing delayed radiation injury, HBOT is likely the most effective treatment available — and it is likely covered by insurance.

• Sherman Oaks: 15301 Ventura Blvd., Suite P12, Sherman Oaks, CA 91403
• Calabasas: 23500 Park Sorrento, A2, Calabasas, CA 91302
• Phone: (818) 661-0939
• Website: oxygenwell.com

Written by Dr. Beth Meneley, DAOM, L.Ac. — Founder of OxygenWell. 25+ years in integrative and functional medicine. 12+ years dedicated to hyperbaric medicine in Los Angeles. Over 50,000 HBOT sessions administered under her clinical direction.