TL;DR: Soft tissue radiation necrosis is a painful and often overlooked complication of radiation therapy that can cause non-healing wounds, fibrosis, and tissue breakdown in the skin, chest wall, pelvic region, and other irradiated areas. Hyperbaric oxygen therapy (HBOT) is one of the most effective treatments available, promoting healing by restoring blood supply to radiation-damaged tissue. This Daffodil Month, we explain what soft tissue necrosis is, review the clinical evidence for HBOT, and outline how Canadian patients can access treatment at hospitals and regulated facilities.
Estimated reading time: 8 minutes
What Is Soft Tissue Radiation Necrosis?
Soft tissue radiation necrosis is a form of delayed radiation injury in which skin, muscle, or connective tissue breaks down after exposure to radiation therapy. Unlike osteoradionecrosis (which affects bone), soft tissue necrosis affects the pliable structures surrounding the treatment area, including the chest wall after breast cancer radiation, the pelvic soft tissues after gynaecological or prostate cancer treatment, and the skin and subcutaneous tissue of the head and neck region.
The condition develops because radiation progressively damages the small blood vessels that supply oxygen and nutrients to tissue. Over months or years, the affected area becomes hypoxic (oxygen-starved), fibrotic (scarred), and unable to heal from normal wear and tear. This is the same “three H” pathology – hypoxic, hypocellular, hypovascular – seen in all forms of delayed radiation injury.
Common symptoms include chronic pain in the irradiated area, skin changes (thickening, discolouration, tightening), non-healing wounds or ulcers, lymphoedema, restricted range of motion, and tissue breakdown that exposes underlying structures. These effects can appear 6 months to many years after completing radiation therapy.
During Daffodil Month, the Canadian Cancer Society’s annual cancer awareness campaign, it is important to recognise that these late effects of treatment are treatable and that effective options exist at hospitals and regulated facilities across Canada.
Which Cancer Survivors Are Most Affected?
Soft tissue radiation necrosis can occur after radiation to any body area, but it is most commonly seen in:
| Cancer Type | Radiation Site | Common Soft Tissue Effects |
|---|---|---|
| Breast cancer | Chest wall, breast | Fibrosis, pain, skin changes, rib fractures, restricted arm movement |
| Cervical / uterine cancer | Pelvis | Vaginal stenosis, pelvic pain, soft tissue fibrosis |
| Prostate cancer | Pelvis | Pelvic floor dysfunction, chronic pain |
| Head and neck cancer | Face, neck, throat | Skin necrosis, trismus, dysphagia, xerostomia |
| Rectal cancer | Pelvis | Perineal wound breakdown, fistulae |
How Does HBOT Treat Soft Tissue Radiation Necrosis?
Hyperbaric oxygen therapy (HBOT) is a medical treatment that delivers 100% oxygen at elevated atmospheric pressure. For soft tissue radiation necrosis, HBOT works by:
- Angiogenesis: Growing entirely new blood vessels in the irradiated tissue, restoring the oxygen supply that radiation destroyed
- Fibroblast stimulation: Activating collagen-producing cells to strengthen and repair weakened tissue
- Reduced fibrosis: Modulating the inflammatory response that drives progressive scarring
- Improved tissue viability: Enhancing oxygen delivery to support wound healing in previously non-healing areas
Treatment typically involves 30 to 60 sessions at 2.0 to 2.4 ATA, delivered once daily on weekdays. Each session lasts 90 to 120 minutes.
What Does the Clinical Evidence Show?
Soft tissue radiation necrosis is well-supported by clinical evidence across multiple cancer types.
The HONEY randomised clinical trial (2024) examined HBOT for late local toxic effects in irradiated breast cancer patients and found that hyperbaric oxygen produced clinically meaningful improvements in tissue quality and symptom reduction (HONEY RCT, 2024).
A 2025 randomised pilot study specifically examining HBOT for radiation-induced dermatitis in breast cancer patients confirmed both efficacy and safety, with measurable improvements in skin condition and patient-reported outcomes (Breast Dermatitis RCT, 2025).
A 2022 systematic review of HBOT for late radiation-induced tissue toxicity in gynaecological cancer patients found positive outcomes across multiple studies, supporting its use for pelvic soft tissue damage (Gynaecological SR, 2022).
A 2025 retrospective analysis of 19 patients treated with HBOT for late radiation tissue injury of the vagina showed reduced symptoms and improved quality of life (Vaginal LRTI Study, 2025).
A 2023 systematic review of HBOT for local late radiation toxicity in breast cancer patients confirmed the therapy’s role in managing chest wall and breast tissue damage after radiation (Breast Late Toxicity SR, 2023).
Soft tissue radiation necrosis falls under the “delayed radiation injury” indication – one of the 14 UHMS-approved uses for HBOT and one of the most widely covered indications across Canadian provinces.
Is HBOT Covered for Soft Tissue Radiation Necrosis in Canada?
Delayed radiation injury, including soft tissue necrosis, is one of the most widely covered HBOT indications in Canada:
- Ontario: OHIP covers HBOT for delayed radiation injury at both hospital-based programs and approved independent facilities
- Alberta: Covered at hospital-based AHS clinics and CPSA-accredited private facilities
- Quebec, British Columbia, Nova Scotia, and Newfoundland: Covered at hospital-based facilities for approved indications
- Other provinces: Interprovincial referral may be available
For a complete province-by-province breakdown, visit the Canada Hyperbarics coverage guide. To find a hospital or regulated facility near you, use the facility finder with postal code search.
Frequently Asked Questions
How do I know if my symptoms are from radiation damage?
If you received radiation therapy and are now experiencing chronic pain, skin changes, non-healing wounds, or tissue tightening in the irradiated area, these may be signs of late radiation tissue injury. Your oncologist, radiation oncologist, or dermatologist can assess the area and confirm whether radiation damage is the cause.
Can HBOT help with radiation fibrosis?
Yes. HBOT promotes angiogenesis (new blood vessel growth) in fibrotic tissue, which can improve tissue quality, reduce pain, and increase range of motion. The HONEY trial showed measurable improvements in irradiated breast tissue after HBOT treatment.
How many HBOT sessions are needed for soft tissue necrosis?
A standard protocol involves 30 to 60 sessions at 2.0 to 2.4 ATA, delivered once daily on weekdays. Your hyperbaric medicine team will assess your response periodically and adjust the treatment plan accordingly.
Is it too late if my radiation was years ago?
No. Soft tissue radiation necrosis can develop at any time after radiation, and HBOT can be effective regardless of when the original treatment occurred. Patients have been successfully treated many years after completing radiation therapy.
This Daffodil Month, Seek Help for Radiation Effects
Soft tissue radiation necrosis is a recognised medical condition with effective, evidence-based treatment available at hospitals and regulated facilities across Canada. If you have been through radiation therapy and are living with chronic pain, skin changes, or non-healing wounds in the treated area, talk to your care team about a referral for HBOT.
Find a hyperbaric facility near you across Canada.
This April, in recognition of Daffodil Month, Canada Hyperbarics is dedicated to helping cancer survivors understand and access treatments for the lasting effects of cancer therapy.
References
- Hyperbaric Oxygen Therapy and Late Local Toxic Effects in Patients With Irradiated Breast Cancer: The HONEY Randomized Clinical Trial. (2024). View in Canada Hyperbarics Research Database.
- Efficacy and Safety of Hyperbaric Oxygen Therapy for Radiation-Induced Dermatitis in Patients With Breast Cancer: A Randomized Pilot Study. (2025). View in Canada Hyperbarics Research Database.
- Hyperbaric Oxygen Treatment for Late Radiation-Induced Tissue Toxicity in Treated Gynaecological Cancer Patients: A Systematic Review. (2022). View in Canada Hyperbarics Research Database.
- Reduced Symptoms of Late Radiation Tissue Injury of the Vagina After Treatment With Hyperbaric Oxygen Therapy: A Retrospective Analysis. (2025). View in Canada Hyperbarics Research Database.
- Hyperbaric Oxygen Therapy for Local Late Radiation Toxicity in Breast Cancer Patients: A Systematic Review. (2023). View in Canada Hyperbarics Research Database.
This content is for informational purposes only and does not constitute medical advice. Hyperbaric oxygen therapy should only be administered by qualified healthcare professionals in accredited facilities. Consult your physician or a certified hyperbaric medicine specialist for treatment decisions. Canada Hyperbarics is an independent educational resource and is not affiliated with any specific clinic or manufacturer.