TLDR: Soft tissue radionecrosis (STNR) is delayed breakdown of radiation-damaged soft tissue, often months to years after cancer radiotherapy. Capillary injury and fibrosis leave tissue hypoxic and fragile. Hyperbaric oxygen therapy is a UHMS-recognized treatment for delayed radiation injury (soft tissue and bony necrosis) and Medicare lists soft tissue radionecrosis as a covered adjunct when criteria are met. Typical courses run about 30 to 40 sessions at roughly 2 to 3 ATA for 90 to 110 minutes; many centers use about 2.4 ATA. StatPearls reports roughly an 80% symptom response rate, with tissue that improves but does not fully return to pre-radiation normal. OxygenWell treats qualifying patients in Sherman Oaks and Calabasas with medical-grade oxygen at pressures up to 2.4 ATA and helps with benefits checks and pre-authorization.
Table of contents
- What is soft tissue radionecrosis?
- Why does it happen months or years later?
- Who develops STNR?
- How hyperbaric oxygen helps
- What treatment looks like
- Does insurance cover STNR HBOT?
- Related radiation injuries
- Care at OxygenWell in Los Angeles
What is soft tissue radionecrosis?
Soft tissue radionecrosis refers to the delayed effects of radiation therapy that break down tissue because blood supply in the radiation field is impaired. Radiation damages capillary beds and arterioles. Relative hypoxia and fibrosis follow. Those changes can appear long after the last radiation fraction. [StatPearls, Hyperbaric Soft Tissue Radionecrosis]
Capillaries can regrow through angiogenesis, but in hypoxic, radiation-damaged tissue new vessels often form in a disorganized pattern and show up as telangiectasias. Perfusion stays inadequate. Minor trauma or surgery in that field can tip the tissue into ulceration and necrosis. Superficial skin and deeper soft tissue can both be involved. Spinal and brain soft-tissue radionecrosis are especially hard to manage. [StatPearls]
Clinically, delayed radiation-damaged skin often looks contracted, feels woody, and has a waxy surface. Telangiectasias are common. Ulcers may open after minor trauma or appear with little warning. [StatPearls]
STNR sits inside the broader category of delayed radiation injury. The Undersea and Hyperbaric Medical Society (UHMS) lists delayed radiation injury (soft tissue and bony necrosis) among approved hyperbaric indications and notes that hyperbaric oxygen has been used for these injuries for more than 30 years. [UHMS, Delayed Radiation Injury] [UHMS HBO Indications]
Why does it happen months or years later?
Therapeutic radiation is meant to kill cancer cells. Normal tissue in the field also absorbs dose. Acute changes (erythema, edema, temporary ulceration) often settle. The delayed problem is progressive vascular injury: obliterative endarteritis, fewer working capillaries, thicker stroma, and longer oxygen diffusion distances. The result is chronic hypoxia and fibrosis that set the stage for breakdown months to years later. [StatPearls]
StatPearls notes soft-tissue radionecrosis can develop 6 months to several years after exposure. Delayed effects may appear within about 6 weeks in some cases or many years later. Cumulative dose is usually over 5000 cGy and can occur with as little as 3000 cGy. Cells that turn over faster (dermis, mucosa, endothelium) take more early damage than slower-dividing muscle or nerve. [StatPearls]
That is why a breast reconstruction incision, a head-and-neck flap, or a pelvic mucosal surface can look stable for a long stretch and then fail after a small insult. The vascular bank account was already low.
Who develops STNR?
In the United States, more than 1.2 million invasive cancers are diagnosed each year, and about half of those patients receive radiation as part of care. About 3% to 5% of patients who receive radiation develop delayed radiation effects such as soft tissue radionecrosis or impaired wound healing. Risk depends on total dose, radiation type, and which tissue was treated. [StatPearls]
Common soft-tissue sites that need hyperbaric support include head and neck, breast or chest wall, and pelvic organs such as bladder and rectum. Any organ in the radiation field can be affected. Related presentations include hemorrhagic radiation cystitis, radiation proctitis, laryngeal radionecrosis, vaginal radionecrosis, and harder central nervous system injuries. [StatPearls]
StatPearls also notes substantial surgical morbidity when further operations are required in an irradiated field (about half of patients experience complications in that setting) and estimates roughly 6,000 to 30,000 patients develop these problems annually in the U.S. [StatPearls]
Evaluation still has to rule out infection, macrovascular disease, pressure or trauma, malnutrition, tobacco use, diabetes, and cancer recurrence or a second primary. Biopsy has a low threshold when a wound will not declare itself. Transcutaneous oxygen above about 40 mm Hg predicts a better chance of wound healing when that test is used. [StatPearls]
How hyperbaric oxygen helps
Standard wound care alone often fails in STNR because the bed cannot deliver enough oxygen and nutrients. Surgery in that field fails more often and can extend the damage. Infection risk rises after procedures. [StatPearls]
Hyperbaric oxygen raises plasma oxygen during each dive and, over a full course, stimulates more organized angiogenesis and granulation. StatPearls describes courses of about 30 to 40 treatments, usually at 2 to 3 ATA for 90 to 110 minutes, as the range that drives new capillary beds and more durable tissue oxygenation. Clinical goals include better chronic wound healing, more tissue elasticity, less fibrosis, less mucosal bleeding, and relief of problems such as xerostomia when salivary tissue was in the field. [StatPearls]
Transient oxygenation during each session matters. Angiogenesis signals build across many dives. StatPearls notes roughly 20 daily treatments before clinical signs of improved angiogenesis and symptom relief often appear, with benefits that may plateau after about 30 to 40 sessions or more. Overall symptom response is described at about 80%. Tissue improves; it does not become pre-radiation normal tissue. [StatPearls]
A published case of soft tissue radionecrosis treated with standard wound care plus 40 multiplace sessions at 2.4 ATA for 2 hours each is one example of how centers operationalize that pressure band. [PMC case report]
OxygenWell sessions use 100% medical-grade oxygen by non-rebreather mask in grounded monoplace chambers rated up to 2.4 ATA. That pressure sits in the range StatPearls cites as a common balance between benefit and oxygen-toxicity risk.
What treatment looks like
A typical radiation soft-tissue course is daily Monday through Friday for many weeks, not a short wellness package. StatPearls describes 2 to 3 ATA for 90 to 110 minutes with brief air breaks every 30 minutes to lower seizure risk from oxygen toxicity, and notes 2.4 ATA as a frequent target pressure. [StatPearls]
Teams watch clinical change, and when useful, tools such as transcutaneous oxygen or fluorescent angiography. Host factors still need work: nutrition, tobacco cessation, offloading, infection control, and vascular assessment. HBOT is an adjunct to conventional care, not a stand-alone fix. [StatPearls] [UHMS]
Risks include ear barotrauma, hypoglycemia in people on insulin or certain diabetes medicines, oxygen-toxicity seizures, pneumothorax, and rare pulmonary oxygen toxicity. Prior bleomycin is a relative concern for later pulmonary fibrosis. Active cisplatin is discussed as a contraindication in the StatPearls review because concurrent HBOT can raise bladder toxicity risk. History of spontaneous pneumothorax and air trapping needs careful screening. [StatPearls]
Sherman Oaks and Calabasas centers run seven days a week, which helps when oncology, wound care, and plastics schedules do not fit a narrow weekday window. Certified Hyperbaric Technicians (many EMT-trained) run treatments, with a PA on site most weekday hours.
Does insurance cover STNR HBOT?
Medicare Part B may cover hyperbaric oxygen therapy in a chamber (including a one-person unit) for listed conditions. The public Medicare coverage page includes soft tissue radionecrosis as an adjunct to conventional treatment, alongside osteoradionecrosis as an adjunct to conventional treatment. Patients usually pay 20% of the Medicare-approved amount after the Part B deductible when coverage applies. [Medicare.gov, Hyperbaric Oxygen Therapy Coverage] [CMS NCD 20.29]
Many PPO plans follow similar on-label radiation-injury logic, but authorization rules, diagnosis coding, and documentation of failed conventional care still decide approval. OxygenWell verifies benefits and handles pre-authorization so oncology and wound teams are not stuck in paperwork while tissue waits.
For a broader insurance walkthrough, see our guide on whether Medicare covers hyperbaric oxygen therapy and the overview of FDA-recognized HBOT indications.
Related radiation injuries
STNR often travels with other delayed radiation problems:
- Osteoradionecrosis (ORN) of bone, including jaw, after head and neck radiation
- Radiation cystitis with hematuria after pelvic radiation (StatPearls cites roughly 80% improvement in hemorrhagic radiation cystitis with HBOT in summarized experience)
- Radiation proctitis with rectal bleeding
- Compromised flaps and grafts in an irradiated field
Read more on our pages covering radiation injuries (ORN, cystitis, and related damage) and compromised skin grafts and flaps. Timing relative to radiation (before, during, after) is covered in our clinical guide to HBOT around radiation therapy.
Care at OxygenWell in Los Angeles
I have spent 25+ years in integrative medicine and 12+ years in hyperbaric practice in Los Angeles. Our team has guided 50,000+ HBOT sessions. Radiation soft-tissue injury is one of the clearest on-label reasons patients and referring oncologists, ENT surgeons, plastics teams, and wound clinics send people to medical-grade chambers rather than mild wellness soft-shell units.
OxygenWell operates in Sherman Oaks and Calabasas with monoplace hard-shell chambers, 100% medical-grade oxygen, pressures up to 2.4 ATA, and open seven-day scheduling. We coordinate with your oncology and surgical team, document medical necessity for payers, and set a protocol length that matches delayed radiation biology, not a short marketing package.
If you have a non-healing wound, fibrotic radiated skin, recurrent bleeding after pelvic radiation, or planned surgery in a prior radiation field, call us to review records and insurance.
(818) 661-0939
www.oxygenwell.com
Sherman Oaks | Calabasas
Dr. Beth Meneley, DAOM, L.Ac., Wellness Director and Co-Owner, OxygenWell
Educational content only. It does not replace evaluation by your oncology, surgical, or hyperbaric care team.