Hyperbaric oxygen to treat radiotherapy complications in Jordan
الأكسجين المضغوط لعلاج مضاعفات العلاج الإشعاعي
Late complications of radiotherapy develop in the tissue that lay inside the radiation field, appearing months or years after treatment ends. Radiation reduces the number of small blood vessels in the area and leaves the tissue poorly perfused, oxygen-poor and cell-poor, so it heals badly and becomes prone to ulceration, fibrosis and infection. Treating these complications with hyperbaric oxygen means sessions of breathing high-concentration oxygen inside a pressurised chamber, raising the oxygen delivered to that tissue and supporting the growth of new vessels within it. This is among the accepted medical uses, and the clearest examples are osteoradionecrosis, particularly of the jaw; ulceration and necrosis of irradiated soft tissue; radiation cystitis with recurrent blood in the urine; radiation proctitis with bleeding; and preparing an irradiated jaw before a tooth extraction or surgery and supporting it afterwards. In these situations hyperbaric oxygen is often paired with surgery rather than replacing it, with sessions before the procedure and further sessions after it. The limits are explicit. Hyperbaric oxygen does not treat the cancer itself and does not replace oncology follow-up, and it is not used for the acute effects that occur during the weeks of radiotherapy, such as acute mucositis or acute skin inflammation, which are managed with other treatments. It does not dissolve established fibrosis or regrow lost tissue, the evidence is not adequate for dry mouth after radiotherapy or for chronic fatigue, and it does not remove the need for targeted antibiotics or for surgical removal of dead tissue. The decision is made by clinical assessment coordinated with the treating team and the oncologist, not by patient request. One worry deserves a direct answer: the available evidence does not support the claim that hyperbaric sessions activate cancer, but the decision still stays coordinated with the oncology team and the disease status is reviewed before starting. The chamber does not suit every patient. Untreated pneumothorax is an absolute barrier, active sinus or ear infection postpones the session, **certain chemotherapy agents conflict with high-concentration oxygen and your medication list must be reviewed carefully**, uncontrolled epilepsy must be controlled first, pregnancy is excluded except in carbon monoxide poisoning, and claustrophobia needs preparation before entry.
Procedure steps
- 1
Documenting the radiation history and defining the problem
Your radiotherapy history is reviewed: which area was irradiated, when, and whether chemotherapy was given alongside. The problem is then defined precisely: exposed or painful bone in the jaw, an ulcer in irradiated skin, recurrent blood in the urine, or rectal bleeding. The necessary imaging or endoscopy is arranged, and recurrence of the original disease is excluded first, a step that is never skipped.
- 2
Coordinating with oncology and reviewing medication
The decision is coordinated with your oncologist and the dentist or surgeon involved, and every medication is reviewed carefully because some chemotherapy agents conflict with high-concentration oxygen. Before entry, the barriers to chamber use are assessed: lungs, heart, ears and sinuses, with questions about epilepsy and pregnancy. Eligibility is set by this joint assessment rather than by patient request.
- 3
Preparatory sessions before surgery or extraction
In an irradiated jaw, and especially before a tooth extraction or surgery, preparatory sessions are given before the procedure to improve tissue perfusion, the procedure is then carried out, and further sessions follow. The sequence is deliberate: sessions prepare the tissue and do not remove the need for surgery to take out dead bone. Beforehand, oral hygiene is optimised and decayed teeth treated to reduce the need for later extractions.
- 4
The session inside the chamber
You are shown in practice how to equalise ear pressure before pressurisation, and fire-safety rules apply: designated clothing, no oils, greasy ointments or perfumes, and no lighters, phones or electronic devices. Pressure is raised gradually, oxygen is breathed for a set period, and pressure is then lowered gradually. **Severe ear pain that does not clear with equalisation, or bleeding from the ear, stops the session.**
- 5
Measuring the result and long-term follow-up
The result is judged by what can be observed objectively: mucosa healing over exposed bone, pain settling, an ulcer shrinking, less bleeding or blood in the urine, and follow-up endoscopy findings. Follow-up remains long term because irradiated tissue stays fragile for life, so regular dental review is advised, complete smoking cessation, and no extraction or surgery in the irradiated area without consulting the team first.
Before the procedure
Bring your radiotherapy records if you have them, and tell the doctor which area was irradiated and when treatment finished, along with every chemotherapy agent you have received or are receiving now, because this information changes the decision rather than being a detail. Report all medications including blood thinners and steroids, and any epilepsy or seizures, chronic lung disease, previous collapsed lung or ear surgery, and say if you are pregnant or might be. If the problem involves the jaw, see a dentist first, optimise oral hygiene and treat what needs treating before the programme. Contact the centre to postpone the session if you develop a cold, blocked nose, or an ear or sinus infection, because a blocked ear is the commonest source of pain inside a chamber, and learn and practise equalisation before entry. Eat a light meal rather than arriving fasting, and check your blood sugar if you have diabetes. Stop smoking completely, as it reduces the oxygen reaching your tissue and works against the treatment. Wear no oil, greasy ointment, perfume or deodorant, and bring no lighter, phone or smart watch into the chamber, as this is a fire-safety rule.
After the procedure
Keep to everything prescribed alongside the sessions: mouth care and rinses if the problem involves the jaw, dressings if there is an ulcer, any antibiotic course completed, and adequate fluids if the bladder is involved. Do not stop any treatment or cancel an oncology appointment because sessions have begun. Do not smoke or use tobacco substitutes, as smoking is the single biggest factor working against healing in irradiated tissue. Do not have a tooth extracted or any surgery in the irradiated area without consulting your team. Check your blood sugar after sessions if you have diabetes, and do not drive while dizzy or with blurred vision. A temporary shift in vision may appear over a long programme and usually reverses after it ends. **Seek care immediately for fever or shivering; increasing jaw swelling and pain, discharge of pus, or a jaw fracture; heavy bleeding from the rectum or bladder or inability to pass urine; an ulcer enlarging rapidly or turning black; severe ear pain, bleeding from the ear or hearing loss; shortness of breath or chest pain; or a seizure or twitching.**
Expected duration
A single session usually lasts sixty to one hundred and twenty minutes, plus preparation and observation. Treatment is an extended programme rather than one visit: typically about twenty to forty sessions or more at roughly one per weekday, sometimes split into sessions before surgery or a tooth extraction and further sessions afterwards, with periodic review of the result.
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