Radiation therapy is an effective treatment for various illnesses. Over time, experts’ procedures and processes during radiation treatment have helped decrease side effects. Still, radiation treatments can cause ulcers for several reasons. Here we will look at radiation therapy, its uses, and explore the causes of ulcers and how wound care doctors treat radiation ulcers with hyperbaric oxygen therapy.
Radiation therapy is a potentially lifesaving treatment for diseases, including cancer. Technological developments are making radiation therapy safer and lowering radiation-induced damage and therapy side effects.
Adjuvant or radiation therapy after surgery is the most used approach in breast cancer. Many experts recognize radiation therapy as a curative therapeutic option for treating certain malignancies. The malignancies can be in the prostate, head, neck, esophageal, brain, and lymphoma.
Despite improvements in many areas, radiation treatment has side effects. Ulcers are one of the side effects caused by radiation therapy. Wound care specialists often help patients heal ulcers from radiation with treatment plans and hyperbaric oxygen chambers.
Radiation ulcers are skin, tissue, or bone injuries caused by radiation therapy. Due to continuous radiation at the ulcer site and diminished/decreased capacity of the body to heal wounds during illness, these ulcers may be difficult to heal.
Skin ulcers can be either immediate or delayed. They occur after exposure to high radiation doses in areas with thin, soft tissue. There may be a higher chance of infection, delayed healing, wound dehiscence, fistula formation, and wound necrosis in irradiated skin. These delayed changes often appear between four and six months after radiation treatment. Ulcers on the skin caused by radiation exposure might become intractable if they don’t heal properly, are infected, or both.
Ulceration and breakdown after radiation therapy can happen from numerous variables, including local tissue tension owing to edema or other factors. In our experience, acute edema from systemic disease or localized swelling of the extremities due to venous insufficiency is the most prevalent immediate cause of radiation ulcers. Minor damage that introduces localized bacteremia and a lack of systemic immunity help fuel growth. These conditions make it harder for blood to reach irradiated tissue. After a certain point, necrosis may start as blood flow stops, leaving a void where bacteria can thrive.
The rate at which radiation damages healthy tissue remains a mystery. Radiation therapy can cause short-term complications. A complication rate of 5-15% is considered acceptable. As a result of advances in cancer treatment, patients live long enough to experience the adverse long-term effects of radiation therapy.
Patients who receive cardiac fluoroscopy for percutaneous coronary intervention develop radiation ulcers 0.42% of the time. (9 out of 2,124 patients). Radiation damage is gradual. Thus soft-tissue ulcers can form at any time. This ulceration may be extensive or seem like a draining sinus. In a previous report, 85% of patients who underwent radiation treatment (RT) noticed a moderate-to-severe skin reaction.
Clinical manifestation of chronic radiation skin injury includes;
Xerosis
Hyperkeratosis
Decreased or absent sweating
Skin atrophy
Depigmentation
Necrosis with full-thickness wounds, and others.
Ionizing radiation immediately affects living organisms- it destroys DNA in cells. Apoptosis, cell cycle arrest, or cell death can all result from this damage. The destruction and cell death may lead to fibrosis. Proinflammatory and profibrotic cytokines like tumor necrosis factor-alpha may lead to fibrosis, a condition that worsens.
Acute high-dose radiation causes obliterative endarteritis and tissue necrosis. Radiation causes dermal and subcutaneous fibrosis. Fibrosis around blood vessels reduces their ability to contract. Endothelial cells and microthrombi may dehisce under electron microscopy. Radiation can directly or indirectly destroy cells. Radiation causes cellular water to liberate free radicals, which form cytotoxic peroxides. These peroxides destroy cellular DNA, leading to cell death, abnormal replication, and cancer. Fibroblasts also undergo direct and indirect cellular changes. Extensive research links fibroblast dysfunction and depletion to soft tissue lesions and ulcerations in irradiated zones.
Erythema is an injury or irritation that causes the dilatation of blood capillaries.
Usually in patches accompanied by superficial skin reddening.
Dermatitis typically refers to skin irritation.
The grades of Radiation dermatitis and injury from erythema to necrotic ulcers are as follow;
Grade 1 – mild redness or desquamation (peeling skin).
Grade 2 – Erythema, moist desquamation, and itching are present in varying degrees. The condition usually stays in the skinfold creases. The injured area may show signs of moderate swelling.
Grade 3 – moist desquamation and skinfold creases; minor trauma may cause bleeding at the injury site.
Grade 4 – skin necrosis and full-thickness wounds are the hallmarks of a level 4 injury. Depending on the severity of the injury, the affected area may bleed spontaneously.
How many types of radiation damage are there?
There are three types of radiation damage.
Acute Damage: Radiation exposure in an industrial accident causes acute damage. The 5,000 – 10,000 rads of orthovoltage radiation induce the damage. The effects on the skin and exposed soft tissues are similar to thermal burns. Pain, swelling, itching, and skin desquamation accompany erythema. The damage can lead to necrosis and endarteritis. Superimposed infections can complicate wound treatment; professionals want to avoid this prognosis.
Subacute Damage: Repeated radiation exposure from therapeutic radiation treatments can cause subacute damage (as an example). Such radiations have less energy than occupational or environmental exposures. The illness causes cutaneous erythema and edema. The erythema is temporary, and necrosis is rare. After many radiation treatments, soft tissues become hyperpigmented.
Chronic radiation damage: Long-term exposures and repetitive occupational exposures cause chronic damage (e.g., in radiology technicians). The fibrosis and thrombosis lead to endarteritis and ischemia. It is similar to subacute injury but more severe for individuals.
Three types of Ulcers:
Mild: Less than 10 cm subcutaneous ulcers with good granulation tissue and no upper/lower limb mobility problems.
Moderate: Over 10 cm, partially exposed bone, no healthy granulation tissue, and upper/lower limb sensory and motor problems.
Severe: Over 100 cm with collarbone and/or rib osteonecrosis and total upper limb loss.
A wound care specialist can utilize treatments to avoid further complications and promote the healing of these wounds. One prevalent therapy is hyperbaric oxygen therapy (HBOT).
In hyperbaric oxygen therapy (HBOT), patients inhale 100 percent oxygen at a pressure higher than normal air. Protocols for hyperbaric oxygen therapy (HBOT) are standardized globally with an application of 2.0–2.8 ATA for 60–90 minutes.
Beneficial therapeutic effects via lowering hypoxia and edema restore normal host responses to the infection.
HBOT employs a hyperbaric chamber with 100 percent oxygen under pressure to encourage the creation of new capillaries in a radiation ulcer. Hyperbaric oxygen therapy facilitates the healing process and is helpful against specific types of illnesses.
It also promotes the creation of new blood vessels, enhancing healing.
Skin ulcers from radiation are severe conditions that require immediate attention from wound care professionals. However, if you are treating the wound locally at the initial stages, below are precautionary measures you should take.
When treating a wound locally, it’s essential to prevent its depth from becoming too wet.
Applying collagenase cream can prevent the wound from developing an inflammatory scar early on, which would otherwise impede the healing process and prevent new blood vessels from forming.
*This information is for educational purposes. Talk with a professional about your individual needs.
Advanced Wound Care Solutions Across the Valley – Phoenix, Mesa, Gilbert.