HORTIS V – Radiation Enteritis
Small and large bowel tolerance to radiation is such that it represents a significant dose limiting effect. This effect can be so profound that resulting dose limitations frequently relegate the role of radiotherapy to one of a surgical adjunct, rather than cure. Lower exposures serve to reduce the likelihood of intestinal late radiation injury.
When such injuries do occur, intestinal appearance is frequently described as mottled and fibrotic, with pale mucosa. Ulceration is a more advanced finding, while stricture and fistulae represent common endpoints. Early symptoms of radiation enteritis present as bloody stool, fecal urgency, cramping and pain.
The underlying pathophysiology is thought to be largely identical to that which injures the mandible, the most common site of radionecrosis. As hyperbaric oxygen therapy has proven particularly helpful in mandibular osteoradionecrosis, one would therefore expect similar outcomes with intestinal radiation-induced injury. However, there has been very little effort to investigate this problem in any systematic way. In fact, there have been very few reports of hyperbaric oxygen's use, even as isolated case reports.
When radiation enteritis does occur they frequently advances to more complicated states, and challenges existing medical and surgical options. Late effects must also be differentiated from tumor recurrence. This process may actually compound any radiation insult by creating a new lesion within tissues poorly supplied with oxygen, the substrate that drives much of the wound repair process.
Given the degree of morbidity that does result, and a limited series of therapeutic measures short of surgical ablation, hyperbaric oxygen therapy is deserving of a closer investigation. HORTIS V has been designed to do just this.
HORTIS V – Radiation
Enteritis Treatment Protocol (pdf, 914KB) 
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