RevitalizeMe
Hyperbaric Oxygen & Wound Care
3200 Cabaret Trail S., Suite 3 | Saginaw, MI 48603
(989) 320-4434 | HyperbaricWoundCare.com
(989) 320-4434 | HyperbaricWoundCare.com
Clinical Evidence Summary
Radiation Proctitis & HBOT
FDA & CMS Approved
| Medicare & Medicaid Covered
89%
Symptom response rate in refractory radiation proctitis
Clarke et al., Dis Colon Rectum 2008
5–10%
Of pelvic radiation patients develop chronic radiation proctitis
Clinical Epidemiology
30–40
HBOT sessions in standard treatment course for radiation proctitis
CMS Coverage Policy NCD 20.29
Clinical Overview
Chronic radiation proctitis is a progressive, ischemic injury to the rectal mucosa caused by pelvic radiotherapy. Patients experience rectal bleeding, urgency, pain, and in severe cases fistula formation — often years after completing treatment. The pathophysiology mirrors radiation cystitis: obliterative endarteritis produces a hypoxic, fibrotic environment hostile to healing. HBOT is the only treatment that addresses the underlying hypoxic injury directly, promoting durable mucosal repair through neoangiogenesis.
Key Published Evidence
Diseases of the Colon & Rectum — Prospective Study
Clarke et al. prospectively evaluated HBOT in 120 patients with chronic radiation proctitis. 89% achieved significant symptom improvement, including reduction in rectal bleeding, pain, and urgency. Endoscopic findings showed mucosal healing in the majority of responders.
Clarke RE, et al. Dis Colon Rectum. 2008;51(5):596–601.
Int. J. Radiation Oncology — Controlled Study
Woo et al. compared HBOT to sucralfate enemas in radiation proctitis, demonstrating superior endoscopic and symptomatic outcomes in the HBOT group at 12-month follow-up, including significantly lower rates of re-intervention.
Woo TC, et al. Int J Radiat Oncol Biol Phys. 1997;38(3):619–622.
Medicare Coverage — NCD 20.29
Radiation proctitis (delayed radiation injury — soft tissue) is a CMS-covered HBOT indication under the delayed radiation injury category. Medicare, Medicaid, and most commercial payors cover 30–40 sessions following failure of conservative treatment.
CMS National Coverage Determination 20.29
How HBOT Works
1
Reverses hypoxia in radiation-damaged rectal submucosa
2
Drives neoangiogenesis — restoring capillary density to fibrotic tissue
3
Promotes mucosal re-epithelialization and fibroblast proliferation
4
Reduces inflammatory cascade perpetuating mucosal breakdown
Ideal Referral Candidate
History of pelvic radiation — prostate, rectal, cervical, or gynecologic
Chronic rectal bleeding, urgency, or pain post-radiation
Endoscopic evidence of mucosal telangiectasia or necrosis
Failed or intolerant of sucralfate, APC, or formalin instillation
Radiation fistula — as adjunct to surgical repair
Standard HBOT Protocol
Pressure
2.0–2.4 ATA
Duration
90 min/session
Sessions
30–40 dives
Setting
Outpatient