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In 2000, when Dr. Wayne Evans and colleagues began exploring radiation therapy complications in Toronto, the most often used therapy to manage late effects was hyperbaric oxygen therapy owing to its long history as a tool to utilize in avoiding surgical misadventure when a surgical procedure was needed in "high risk tissue", that is, tissue which had been previously irradiated.
The Nature of the Injury: Microscopic changes are seen in previously irradiated tissue, which include a reduction of blood supply to the tissues along with reduced cell count. As such the vascular density is reduced and the tissues may be starved for oxygen and nutrients. Thus, a state of chronic hypoxia develops in a setting of insufficient repair cells to manage wear and tear at the cellular level.
In addition, there exists in radiation damaged tissue a chronic state of inflammation which slowly debilitates the tissue. This is known as fibroatrophic remodeling or degeneration.
A, Hyperbaric Oxygen Therapy
- The use of oxygen under pressure in rehabilitation of radiotherapy damaged tissue dates to the 1970’s and the science was advanced in the 1980s and 1990s most notably by the voluminous work of Dr. Robert Marx, a US army oral surgeon who was able to develop well defined strategies for managing radiotherapy injury to the jaw. The use of hyperbaric oxygen therapy has been more widely applied since that time and of late the most success has been found in abdominal and pelvic problems affecting the gastrointestinal and urinary systems. Dr. Evans & colleagues published a small series of cases on this in 2006 prior to a large randomized trial on radiation proctitis in 2008 which demonstrated a strong outcome advantage with the use of hyperbaric oxygen therapy.
- A combination of long existing chemicals has been popularized of late to battle the key degenerative manifestations of the above problems. Various combinations of oral tablets have been considered. A combination, known as PENTOCLO has become popular in recent years due to the work of a French Radiation Oncologist named Sofie Delanian. It requires long term use (min 2-3 years) and can be helpful in many cases.
C. DIETARY MEASURES
- It is not news that we need to be aware of the biological impact that our food intake has on our health. The term “anti-inflammatory diet" has become understood as a nutritional approach which may reduce biochemical stress which impairs repair and recovery.There is a growing body of evidence from a range of medical specialties which instructs us to follow such advice. This is an area of growing knowledge and ongoing evaluation.
D. PHYSICAL MEDICINE AND LOCAL MEASURES
- We have found many therapies useful in selected cases. Local injection with steroids, vasodilators, and anesthetics are used. Lymphedema and reduced range of motion can often respond to massage and physiotherapy.