Hyperbaric oxygen for radiation injury: is it indicated?

the Cochrane review, with its emphasis on randomized controlled trials, does not advocate universal application of HBO2 to delayed radiation injuries. In the United States, third-party insurance entities will frequently reimburse for this application, but often a formal appeal will be required to obtain payment. In informal surveys of HBO2 practitioners at continuing medical education meetings on hyperbaric oxygen, I have consistently found that between one third and one half of U.S. patients treated with HBO2 are treated for delayed radiation injuries. A landmark development in the science supporting HBO2 for radiation injury is the publication, in the International Journal of Radiation Oncology, of the results of a randomized trial for patients with radiation proctitis. This multi-institutional blinded trial was sponsored by the Baromedical Research Foundation (http://www.baromedicalresearch.org). That foundation is in the process of completing similar studies in radiation injury (called the Hyperbaric Oxygen Radiation Tissue Injury Study) including osteoradiation necrosis, soft-tissue radiation necrosis, laryngeal radiation necrosis, radiation-induced cystitis, and gynecologic injuries. Another study in the same series will examine the role of HBO2 in the prevention of serious injuries. Craighead et al. conclude that