Top

International Journal of Colorectal Disease

Published in:

Open Access 01-10-2015 | Review

Chronic radiation proctitis: tricks to prevent and treat

Authors: Ben G. L. Vanneste, Lien Van De Voorde, Rogier J. de Ridder, Evert J. Van Limbergen, Philippe Lambin, Emile N. van Lin

Published in: International Journal of Colorectal Disease | Issue 10/2015

Abstract

Objective

The purpose of this study was to give an overview of the measures used to prevent chronic radiation proctitis (CRP) and to provide an algorithm for the treatment of CRP.

Methods

Medical literature databases including PubMed and Medline were screened and critically analyzed for relevance in the scope of our purpose.

Results

CRP is a relatively frequent late side effect (5–20%) and mainly dependent on the dose and volume of irradiated rectum. Radiation treatment (RT) techniques to prevent CRP are constantly improving thanks to image-guided RT and intensity-modulated RT. Also, newer techniques like protons and new devices such as rectum spacers and balloons have been developed to spare rectal structures. Biopsies do not contribute to diagnosing CRP and should be avoided because of the risk of severe rectal wall damage, such as necrosis and fistulas. There is no consensus on the optimal treatment of CRP. A variety of possibilities is available and includes topical and oral agents, hyperbaric oxygen therapy, and endoscopic interventions.

Conclusions

CRP has a natural history of improving over time, even without treatment. This is important to take into account when considering these treatments: first be conservative (topical and oral agents) and be aware that invasive treatments can be very toxic.

Garg AK, Mai WY, McGary JE, Grant WH 3rd, Butler EB, Teh BS (2006) Radiation proctopathy in the treatment of prostate cancer. Int J Radiat Oncol Biol Phys 66(5):1294–1305. doi:10.1016/j.ijrobp.2006.07.1386 PubMedCrossRef

Kuku S, Fragkos C, McCormack M, Forbes A (2013) Radiation-induced bowel injury: the impact of radiotherapy on survivorship after treatment for gynaecological cancers. Br J Cancer 109(6):1504–1512. doi:10.1038/bjc.2013.491 PubMedCentralPubMedCrossRef

Krol R, Smeenk RJ, van Lin EN, Yeoh EE, Hopman WP (2014) Systematic review: anal and rectal changes after radiotherapy for prostate cancer. Int J Color Dis 29(3):273–283. doi:10.1007/s00384-013-1784-8 CrossRef

Talcott JA, Manola J, Clark JA, Kaplan I, Beard CJ, Mitchell SP, Chen RC, O’Leary MP, Kantoff PW, D’Amico AV (2003) Time course and predictors of symptoms after primary prostate cancer therapy. J Clin Oncol 21(21):3979–3986. doi:10.1200/JCO.2003.01.199 PubMedCrossRef

Shadad AK, Sullivan FJ, Martin JD, Egan LJ (2013) Gastrointestinal radiation injury: symptoms, risk factors and mechanisms. World J Gastroenterol 19(2):185–198. doi:10.3748/wjg.v19.i2.199 PubMedCentralPubMedCrossRef

Theis VS, Sripadam R, Ramani V, Lal S (2010) Chronic radiation enteritis. Clin Oncol (R Coll Radiol) 22(1):70–83. doi:10.1016/j.clon.2009.10.003 CrossRef

Valdagni R, Rancati T, Fiorino C, Fellin G, Magli A, Baccolini M, Bianchi C, Cagna E, Greco C, Mauro FA, Monti AF, Munoz F, Stasi M, Franzone P, Vavassori V (2008) Development of a set of nomograms to predict acute lower gastrointestinal toxicity for prostate cancer 3D-CRT. Int J Radiat Oncol Biol Phys 71(4):1065–1073. doi:10.1016/j.ijrobp.2007.11.037 PubMedCrossRef

Valdagni R, Kattan MW, Rancati T, Yu C, Vavassori V, Fellin G, Cagna E, Gabriele P, Mauro FA, Baccolini M, Bianchi C, Menegotti L, Monti AF, Stasi M, Giganti MO, Fiorino C (2012) Is it time to tailor the prediction of radio-induced toxicity in prostate cancer patients? Building the first set of nomograms for late rectal syndrome. Int J Radiat Oncol Biol Phys 82(5):1957–1966. doi:10.1016/j.ijrobp.2011.03.028 PubMedCrossRef

Dörr W (2015) Radiobiology of tissue reactions. Ann ICRP. doi:10.1177/0146645314560686 PubMed

10.

National Cancer Institute (2013) Common Terminology Criteria for Adverse Events (CTCAE) 4.0. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm. Accessed 18 May 2015

11.

Gami B, Harrington K, Blake P, Dearnaley D, Tait D, Davies J, Norman AR, Andreyev HJ (2003) How patients manage gastrointestinal symptoms after pelvic radiotherapy. Aliment Pharmacol Ther 18(10):987–994. doi:10.1046/j.1365-2036.2003.01760.x PubMedCrossRef

12.

Gillespie C, Goode C, Hackett C, Andreyev HJ (2007) The clinical needs of patients with chronic gastrointestinal symptoms after pelvic radiotherapy. Aliment Pharmacol Ther 26(4):555–563. doi:10.1111/j.1365-2036.2007.03405 PubMedCrossRef

13.

Andreyev HJ, Benton BE, Lalji A, Norton C, Mohammed K, Gage H, Pennert K, Lindsay JO (2013) Algorithm-based management of patients with gastrointestinal symptoms in patients after pelvic radiation treatment (ORBIT): a randomised controlled trial. Lancet 382(9910):2084–2092. doi:10.1016/s0140-6736(13)61648-7 PubMedCrossRef

14.

Leiper K, Morris AI (2007) Treatment of radiation proctitis. Clin Oncol (R Coll Radiol) 19(9):724–729. doi:10.1016/j.clon.2007.07.008 CrossRef

15.

Wu XR, Liu XL, Katz S, Shen B (2015) Pathogenesis, diagnosis, and management of ulcerative proctitis, chronic radiation proctopathy, and diversion proctitis. Inflamm Bowel Dis 21(3):703–715. doi:10.1097/mib.0000000000000227 PubMedCrossRef

16.

Moore EM, Magrino TJ, Johnstone PA (2000) Rectal bleeding after radiation therapy for prostate cancer: endoscopic evaluation. Radiology 217:215–218. doi:10.1148/radiology.217.1.r00oc24215 PubMedCrossRef

17.

Reichelderfer M, Morrissey JF (1980) Colonoscopy in radiation colitis. Gastrointest Endosc 26:41–43. doi:10.1016/s0016-5107(80)73265-0 PubMedCrossRef

18.

Wachter S, Gerstner N, Goldner G, Potzi R, Wambersie A, Potter R (2000) Endoscopic scoring of late rectal mucosal damage after conformal radiotherapy for prostatic carcinoma. Radiother Oncol 54(1):11–19. doi:10.1016/s0167-8140(99)00173-5 PubMedCrossRef

19.

Chi KD, Ehrenpreis ED, Jani AB (2005) Accuracy and reliability of the endoscopic classification of chronic radiation-induced proctopathy using a novel grading method. J Clin Gastroenterol 39(1):42–46PubMed

20.

Chrouser KL, Leibovich BC, Sweat SD, Larson DW, Davis BJ, Tran NV, Zincke H, Blute ML (2005) Urinary fistulas following external radiation or permanent brachytherapy for the treatment of prostate cancer. J Urol 173(6):1953–1957. doi:10.1097/01.ju.0000158041.77063.ff PubMedCrossRef

21.

Theodorescu D, Gillenwater J, Koutrouvelis P (2000) Prostatourethral-rectal fistula after prostate brachytherapy. Cancer 89:2085–2091. doi:10.1002/1097-0142(20001115)89:10<2085::aid-cncr8>3.0.co;2-q PubMedCrossRef

22.

Thornhill JA, Long RM, Neary P, O’Connor HJ, Ryan B, Fraser I (2012) The pitfalls of treating anorectal conditions after radiotherapy for prostate cancer. Ir Med J 105:91–93PubMed

23.

Fonteyne V, De Neve W, Villeirs G, De Wagter C, De Meerleer G (2007) Late radiotherapy-induced lower intestinal toxicity (RILIT) of intensity-modulated radiotherapy for prostate cancer: the need for adapting toxicity scales and the appearance of the sigmoid colon as co-responsible organ for lower intestinal toxicity. Radiother Oncol 84(2):156–163. doi:10.1016/j.radonc.2007.06.013 PubMedCrossRef

24.

West C, Azria D, Chang-Claude J, Davidson S, Lambin P, Rosenstein B, De Ruysscher D, Talbot C, Thierens H, Valdagni R, Vega A, Yuille M (2014) The REQUITE project: validating predictive models and biomarkers of radiotherapy toxicity to reduce side-effects and improve quality of life in cancer survivors. Clin Oncol (R Coll Radiol) 26(12):739–742. doi:10.1016/j.clon.2014.09.008 CrossRef

25.

Fachal L, Gómez-Caamaño A, Barnett GC, Peleteiro P, Carballo AM, Calvo-Crespo P, Kerns SL, Sánchez-García M, Lobato-Busto R, Dorling L, Elliott RM, Dearnaley DP, Sydes MR, Hall E, Burnet NG, Carracedo Á, Rosenstein BS, West CM, Dunning AM, Vega A (2014) A three-stage genome-wide association study identifies a susceptibility locus for late radiotherapy toxicity at 2q24.1. Nat Genet 46(8):891–894. doi:10.1038/ng.3020 PubMedCrossRef

26.

West CM, Barnett GC (2011) Genetics and genomics of radiotherapy toxicity: towards prediction. Genome Med 3(8):52. doi:10.1186/gm268 PubMedCentralPubMedCrossRef

27.

Zelefsky MJ, Fuks Z, Hunt M, Yamada Y, Marion C, Ling CC, Amols H, Venkatraman ES, Leibel SA (2002) High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. Int J Radiat Oncol Biol Phys 53:1111–1116. doi:10.1016/s0360-3016(02)02857-2 PubMedCrossRef

28.

De Meerleer GO, Fonteyne VH, Vakaet L, Villeirs GM, Denoyette L, Verbaeys A, Lummen N, De Neve WJ (2007) Intensity-modulated radiation therapy for prostate cancer: late morbidity and results on biochemical control. Radiother Oncol 82:160–166. doi:10.1016/j.radonc.2006.12.007 PubMedCrossRef

29.

Wortel RC, Incrocci L, Pos FJ, Lebesque JV, Witte MG, van der Heide UA, van Herk M, Heemsbergen WD (2015) Acute toxicity after image-guided intensity modulated radiation therapy compared to 3D conformal radiation therapy in prostate cancer patients. Int J Radiat Oncol Biol Phys 91(4):737–744. doi:10.1016/j.ijrobp.2014.12.017 PubMedCrossRef

30.

Zietman A (2013) Proton beam and prostate cancer: an evolving debate. Rep Pract Oncol Radiother 18(6):338–342. doi:10.1016/j.rpor.2013.06.001 PubMedCentralPubMedCrossRef

31.

Shioyama Y, Tsuji H, Suefuji H, Sinoto M, Matsunobu A, Toyama S, Nakamura K, Kudo S (2015) Particle radiotherapy for prostate cancer. Int J Urol 22(1):33–39. doi:10.1111/iju.12640 PubMedCrossRef

32.

Georg D, Hopfgartner J, Gòra J, Kuess P, Kragl G, Berger D, Hegazy N, Goldner G, Georg P (2014) Dosimetric considerations to determine the optimal technique for localized prostate cancer among external photon, proton, or carbon-ion therapy and high-dose-rate or low-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 88(3):715–722. doi:10.1016/j.ijrobp.2013.11.241 PubMedCrossRef

33.

Stellamans K, Lievens Y, Lambin P, Van den Weyngaert D, Van den Bogaert W, Scalliet P, Hutsebaut L, Haustermans K (2002) Does sucralfate reduce early side effects of pelvic radiation? A double-blind randomized trial. Radiother Oncol 65(2):105–108PubMedCrossRef

34.

Athanassiou H, Antonadou D, Coliarakis N, Kouveli A, Synodinou M, Paraskevaidis M, Sarris G, Georgakopoulos GR, Panousaki K, Karageorgis P, Throuvalas N, Oncology Hellenic Group (2003) Protective effect of amifostine during fractionated radiotherapy in patients with pelvic carcinomas: results of a randomized trial. Int J Radiat Oncol Biol Phys 56(4):1154–1160. doi:10.1016/s0360-3016(03)00187-1 PubMedCrossRef

35.

Jahraus CD, Bettenhausen D, Malik U, Sellitti M, St Clair WH (2005) Prevention of acute radiation-induced proctosigmoiditis by balsalazide: a randomized, double-blind, placebo controlled trial in prostate cancer patients. Int J Radiat Oncol Biol Phys 63(5):1483–1487. doi:10.1016/j.ijrobp.2005.04.032 PubMedCrossRef

36.

Simone NL, Ménard C, Soule BP, Albert PS, Guion P, Smith S, Godette D, Crouse NS, Sciuto LC, Cooley-Zgela T, Camphausen K, Coleman CN, Singh AK (2008) Intrarectal amifostine during external beam radiation therapy for prostate cancer produces significant improvements in quality of life measured by EPIC score. Int J Radiat Oncol Biol Phys 70(1):90–95. doi:10.1016/j.ijrobp.2007.05.057 PubMedCentralPubMedCrossRef

37.

Kneebone A, Mameghan H, Bolin T, Berry M, Turner S, Kearsley J, Graham P, Fisher R, Delaney G (2004) Effect of oral sucralfate on late rectal injury associated with radiotherapy for prostate cancer: a double-blind, randomized trial. Int J Radiat Oncol Biol Phys 60(4):1088–1097. doi:10.1016/j.ijrobp.2004.04.033 PubMedCrossRef

38.

Koukourakis MI, Kyrgias G, Panteliadou M, Papadopoulou A, Tsiarkatsi M, Papachristou E, Bebeli M (2013) Dose escalation of amifostine for radioprotection during pelvic accelerated radiotherapy. Am J Clin Oncol 36(4):338–343. doi:10.1097/coc.0b013e318248d882 PubMedCrossRef

39.

Ferreira MR, Muls A, Dearnaley DP, Andreyev HJ (2014) Microbiota and radiation-induced bowel toxicity: lessons from inflammatory bowel disease for the radiation oncologist. Lancet Oncol 15(3):e139–e147. doi:10.1016/s1470-2045(13)70504-7 PubMedCrossRef

40.

Nascimento M, Aguilar-Nascimento JE, Caporossi C, Castro-Barcellos HM, Motta RT (2014) Efficacy of synbiotics to reduce acute radiation proctitis symptoms and improve quality of life: a randomized, double-blind, placebo-controlled pilot trial. Int J Radiat Oncol Biol Phys 90(2):289–295. doi:10.1016/j.ijrobp.2014.05.049 PubMedCrossRef

41.

Smeenk RJ, van Lin ENJT (2013) Application of anorectal sparing devices in prostate radiotherapy. Radiother Oncol 106(2):155–156. doi:10.1016/j.radonc.2013.02.004 PubMedCrossRef

42.

Van Lin EN, Kristinsson J, Philippens ME, de Jong DJ, Van DV, Kaanders JH, Leer JW, Visser AG (2007) Reduced late rectal mucosal changes after prostate three-dimensional conformal radiotherapy with endorectal balloon as observed in repeated endoscopy. Int J Radiat Oncol Biol Phys 67:799–811. doi:10.1016/j.ijrobp.2006.09.034 PubMedCrossRef

43.

Hatiboglu G, Pinkawa M, Vallee JP, Hadaschik B, Hohenfellner M (2012) Application technique: placement of a prostate-rectum spacer in men undergoing prostate radiation therapy. BJU Int 110:e647–e652. doi:10.1111/j.1464-410x.2012.11373.x PubMedCrossRef

44.

Mok G, Benz E, Vallee JP, Miralbell R, Zilli T (2014) Optimization of radiation therapy techniques for prostate cancer with prostate-rectum spacers: a systematic review. Int J Radiat Oncol Biol Phys 90(2):278–288. doi:10.1016/j.ijrobp.2014.06.044 PubMedCrossRef

45.

Pinkawa M (2014) Spacer application for prostate cancer radiation therapy. Future Oncol 10(5):851–864. doi:10.2217/fon.13.223 PubMedCrossRef

46.

Schutzer ME, Orio PF, Biagioli MC, Asher DA, Lomas H, Moghanaki D (2015) A review of rectal toxicity following permanent low dose-rate prostate brachytherapy and the potential value of biodegradable rectal spacers. Prostate Cancer Prostatic Dis 18(2):96–103. doi:10.1038/pcan.2015.4 PubMedCrossRef

47.

Prada PJ, Fernández J, Martinez AA, de la Rúa A, Gonzalez JM, Fernandez JM, Juan G (2007) Transperineal injection of hyaluronic acid in anterior perirectal fat to decrease rectal toxicity from radiation delivered with intensity modulated brachytherapy or EBRT for prostate cancer patients. Int J Radiat Oncol Biol Phys 69(1):95–102. doi:10.1016/j.ijrobp.2007.02.034 PubMedCrossRef

48.

Wilder RB, Barme GA, Gilbert RF et al (2010) Cross-linked hyaluronan gel reduces the acute rectal toxicity of radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 77(3):824–830. doi:10.1016/j.ijrobp.2009.05.069 PubMedCrossRef

49.

Susil RC, McNutt TR, DeWeese TL et al (2010) Effects of prostate-rectum separation on rectal dose from external beam radiotherapy. Int J Radiat Oncol Biol Phys 76:1251–1258. doi:10.1016/j.ijrobp.2009.07.1679 PubMedCentralPubMedCrossRef

50.

Noyes WR, Hosford CC, Schultz SE (2012) Human collagen injections to reduce rectal dose during radiotherapy. Int J Radiat Oncol Biol Phys 82(5):1918–1922. doi:10.1016/j.ijrobp.2011.02.034 PubMedCrossRef

51.

Pinkawa M, Corral NE, Caffaro M et al (2011) Application of a spacer gel to optimize three-dimensional conformal and intensity modulated radiotherapy for prostate cancer. Radiother Oncol 100(3):436–441. doi:10.1016/j.radonc.2011.09.005 PubMedCrossRef

52.

Uhl M, van Triest B, Eble MJ, Weber DC, Herfarth K, De Weese TL (2013) Low rectal toxicity after dose escalated IMRT treatment of prostate cancer using an absorbable hydrogel for increasing and maintaining space between the rectum and prostate: results of a multi-institutional phase II trial. Radiother Oncol 106(2):215–219. doi:10.1016/j.radonc.2012.11.009 PubMedCrossRef

53.

Melchert C, Gez E, Bohlen G et al (2013) Interstitial biodegradable balloon for reduced rectal dose during prostate radiotherapy: results of a virtual planning investigation based on the pre- and post-implant imaging data of an international multicenter study. Radiother Oncol 106(2):210–214. doi:10.1016/j.radonc.2013.01.007 PubMedCrossRef

54.

Song DY, Herfarth KK, Uhl M et al (2013) A multi-institutional clinical trial of rectal dose reduction via injected polyethylene-glycol hydrogel during intensity modulated radiation therapy for prostate cancer: analysis of dosimetric outcomes. Int J Radiat Oncol Biol Phys 87:81–87. doi:10.1016/j.ijrobp.2012.12.019 PubMedCentralPubMedCrossRef

55.

Strom TJ, Wilder RB, Fernandez DC et al (2014) A dosimetric study of polyethylene glycol hydrogel in 200 prostate cancer patients treated with high-dose rate brachytherapy±intensity modulated radiation therapy. Radiother Oncol 111:126–131. doi:10.1016/j.radonc.2014.02.011 PubMedCrossRef

56.

Vanneste BG, Pijls-Johannesma M, Van De Voorde L, van Lin EN, van de Beek K, van Loon J, Ramaekers BL, Lambin P (2015) Spacers in radiotherapy treatment of prostate cancer: is reduction of toxicity cost-effective? Radiother Oncol 114(2):276–281. doi:10.1016/j.radonc.2015.01.005 PubMedCrossRef

57.

Denton A, Andreyev J, Forbes A, Maher EJ (2002) Non-surgical interventions for late radiation proctitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev 1, CD003455. doi:10.1002/14651858.CD003455 PubMed

58.

Hanson B, MacDonald R, Shaukat A (2012) Endoscopic and medical therapy for chronic radiation proctopathy: a systematic review. Dis Colon Rectum 55(10):1081–1095. doi:10.1097/dcr.0b013e3182587aef PubMedCrossRef

59.

Mendenhall WM, McKibben BT, Hoppe BS, Nichols RC, Henderson RH, Mendenhall NP (2014) Management of radiation proctitis. Am J Clin Oncol 37(5):517–523. doi:10.1097/coc.0b013e318271b1aa PubMedCrossRef

60.

Andreyev HJN, Davidson SE, Gillespie C et al (2012) Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer. Gut 61(2):179–192. doi:10.1136/gutjnl-2011-300563 PubMedCentralPubMedCrossRef

61.

Kochhar R, Patel F, Dhar A, Sharma SC, Ayyagari S, Aggarwal R, Goenka MK, Gupta BD, Mehta SK (1991) Radiation-induced proctosigmoiditis. Prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate. Dig Dis Sci 36(1):103–107. doi:10.1007/bf01300096 PubMedCrossRef

62.

Kochhar R, Sriram PV, Sharma SC, Goel RC, Patel F (1999) Natural history of late radiation proctosigmoiditis treated with topical sucralfate suspension. Dig Dis Sci 44(5):973–978. doi:10.1023/A:1026612731210 PubMedCrossRef

63.

Cavcic J, Turcic J, Martinac P et al (2000) Metronidazole in the treatment of chronic radiation proctitis: clinical trial. Croat Med J 41:314–318PubMed

64.

Ehrenpreis E, Jani A, Levitsky J et al (2005) A prospective, randomized, double-blind, placebo-controlled trial of retinol palmitate (vitamin A) for symptomatic chronic radiation proctopathy. Dis Colon Rectum 48:1–8. doi:10.1007/s10350-004-0821-7 PubMedCrossRef

65.

Clarke RE, Tenorio LM, Hussey JR et al (2008) Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a randomized and controlled double-blind crossover trial with long-term follow-up. Int J Radiat Oncol Biol Phys 72:134–143. doi:10.1016/j.ijrobp.2007.12.048 PubMedCrossRef

66.

Szabo S, Vattay P, Scarbrough E et al (1991) Role of vascular factors, including angiogenesis, in the mechanisms of action of sucralfate. Am J Med 91:S158–S160. doi:10.1016/0002-9343(91)90469-e CrossRef

67.

Hanauer SB (1990) Inflammatory bowel disease revisited: newer drugs. Scand J Gastroenterol Suppl 25(s175):97–106. doi:10.3109/00365529009093133 CrossRef

68.

Goodman LS, Gilman A (1996) The pharmacological basis of therapeutics, 9th edn. McGraw-Hill, New York, pp 995–998

69.

Shadad AK, Sullivan FJ, Martin JD, Egan LJ (2013) Gastrointestinal radiation injury: prevention and treatment. World J Gastroenterol 19(2):199–208. doi:10.3748/wjg.v19.i2.199 PubMedCentralPubMedCrossRef

70.

Kennedy M, Bruninga K, Mutlu EA, Losurdo J, Choudhary S, Keshavarzian A (2001) Successful and sustained treatment of chronic radiation proctitis with antioxidant vitamins E and C. Am J Gastroenterol 96:1080–1084. doi:10.1111/j.1572-0241.2001.03742.x PubMedCrossRef

71.

Feldmeier JJ, Hampson NB (2002) A systematic review of the literature reporting the application of hyperbaric oxygen prevention and treatment of delayed radiation injuries: an evidence based approach. Undersea Hyperb Med 29:4–30PubMed

72.

Marx RE (1983) A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg 41:351–357. doi:10.1016/s0278-2391(83)80005-6 PubMedCrossRef

73.

Marx RE, Ehler WJ, Tayapongsak P et al (1990) Relationship of oxygen dose to angiogenesis induction in irradiated tissue. Am J Surg 160:519–524PubMedCrossRef

74.

Bennett MH, Feldmeier J, Hampson N, Smee R, Milross C (2012) Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev 5, CD005005. doi:10.1002/14651858.CD005005.pub3 PubMed

75.

Kishan AU, Kupelian PA (2015) Late rectal toxicity after low-dose-rate brachytherapy: incidence, predictors, and management of side effects. Brachytherapy 14(2):148–159. doi:10.1016/j.brachy.2014.11.005 PubMedCrossRef

76.

Phan J, Swanson DA, Levy LB, Kudchadker RJ, Bruno TL, Frank SJ (2009) Late rectal complications after prostate brachytherapy for localized prostate cancer: incidence and management. Cancer 115(9):1827–1839. doi:10.1002/cncr.24223 PubMedCrossRef

77.

Farin G, Grund KE (1994) Technology of argon plasma coagulation with particular regard to endoscopic applications. Endosc Surg Allied Technol 2:71–77PubMed

78.

Tjandra JJ, Sengupta S (2001) Argon plasma coagulation is an effective treatment for refractory hemorrhagic radiation proctitis. Dis Colon Rectum 44(12):1759–1765. doi:10.1007/bf02234451 PubMedCrossRef

79.

Swan MP, Moore GT, Sievert W et al (2010) Efficacy and safety of single session argon plasma coagulation in the management of chronic radiation proctitis. Gastrointest Endosc 72:150–154. doi:10.1016/j.gie.2010.01.065 PubMedCrossRef

80.

Villavicencio RT, Rex DK, Rahmani E (2002) Efficacy and complications of argon plasma coagulation for hematochezia related to radiation proctopathy. Gastrointest Endosc 55(1):70–74. doi:10.1067/mge.2002.119877 PubMedCrossRef

81.

Karamanolis G, Triantafyllou K, Tsiamoulos Z, Polymeros D, Kalli T, Misailidis N, Ladas SD (2009) Argon plasma coagulation has a long-lasting therapeutic effect in patients with chronic radiation proctitis. Endoscopy 41(6):529–531. doi:10.1055/s-0029-1214726 PubMedCrossRef

82.

Soussan BE, Mathieu N, Roque I, Antonietti M (2003) Bowel explosion with colonic perforation during argon plasma coagulation for hemorrhagic radiation-induced proctitis. Gastrointest Endosc 57(3):412–413. doi:10.1067/mge.2003.131 PubMedCrossRef

83.

Taieb S, Rolachon A, Cenni JC et al (2001) Effective use of argon plasma coagulation in the treatment of severe radiation proctitis. Dis Colon Rectum 44(12):1766–1771. doi:10.1007/bf02234452 PubMedCrossRef

84.

Canard JM, Védrenne B, Bors G et al (2003) Long term results of treatment of hemorrhagic radiation proctitis by argon plasma coagulation. Gastroenterol Clin Biol 27(5):455–459PubMed

85.

Dees J, Maarten AC, Meijssen MA, Kuipers EJ (2006) Argon plasma coagulation for radiation proctitis. Scand J Gastroenterol Suppl 41(s243):175–178. doi:10.1080/00365520600664300 CrossRef

86.

Fenwick JD, Khoo VS, Nahum AE, Sanchez-Nieto B, Dearnaley DP (2001) Correlations between dose-surface histograms and the incidence of long-term rectal bleeding following conformal or conventional radiotherapy treatment of prostate cancer. Int J Radiat Oncol Biol Phys 49(2):473–480PubMedCrossRef

87.

Rotondano G, Bianco MA, Marmo R et al (2003) Long-term outcome of argon plasma coagulation therapy for bleeding caused by chronic radiation proctopathy. Dig Liver Dis 35(11):806–810. doi:10.1016/s1590-8658(03)00454-7 PubMedCrossRef

88.

Tam W, Moore J, Schoeman M (2000) Treatment of radiation proctitis with argon plasma coagulation. Endoscopy 32(9):667–672. doi:10.1055/s-2000-9020 PubMedCrossRef

89.

Zinicola R, Rutter MD, Falasco G, Brooker JC, Cennamo V, Contini S, Saunders BP (2003) Haemorrhagic radiation proctitis: endoscopic severity may be useful to guide therapy. Int J Color Dis 18(5):439–444. doi:10.1007/s00384-003-0487-y CrossRef

90.

Venkatesh KS, Ramanujam P (2002) Endoscopic therapy for radiation proctitis-induced hemorrhage in patients with prostatic carcinoma using argon plasma coagulator application. Surg Endosc 16(4):707–710. doi:10.1007/s00464-001-8164-0 PubMedCrossRef

91.

Ravizza D, Giancarla F, Trovato C, Crosta C (2003) Frequency and outcomes of rectal ulcers during argon plasma coagulation for chronic radiation-induced proctopathy. Gastrointest Endosc 57(4):519–525. doi:10.1067/mge.2003.144 PubMedCrossRef

92.

Andreyev HJ (2007) Argon plasma coagulation in chronic radiation proctitis: Postgate et al. Endoscopy 39(8):751–752. doi:10.1055/s-2007-966772 PubMedCrossRef

93.

Andreyev HJ (2007) Gastrointestinal symptoms after pelvic radiotherapy: a new understanding to improve management of symptomatic patients. Lancet Oncol 8(11):1007–1017. doi:10.1016/s1470-2045(07)70341-8 PubMedCrossRef

94.

Sebastian S, O’Connor H, O’Morain C et al (2004) Argon plasma coagulation as first-line treatment for chronic radiation proctopathy. J Gastroenterol Hepatol 19(10):1169–1173. doi:10.1111/j.1440-1746.2004.03448.x PubMedCrossRef

95.

Haas EM, Bailey HR, Farragher I (2007) Application of 10 percent formalin for the treatment of radiation-induced hemorrhagic proctitis. Dis Colon Rectum 50(2):213–217. doi:10.1007/s10350-006-0707-y PubMedCrossRef

96.

Parikh S, Hughes C, Salvati EP, Eisenstat T, Oliver G, Chinn B, Notaro J (2003) Treatment of hemorrhagic radiation proctitis with 4 percent formalin. Dis Colon Rectum 46(5):596–600. doi:10.1007/s10350-004-6614-1 PubMedCrossRef

97.

Henson C (2010) Chronic radiation proctitis: issues surrounding delayed bowel dysfunction post-pelvic radiotherapy and an update on medical treatment. Ther Adv Gastroenterol 3(6):359–365. doi:10.1177/1756283x10371558 CrossRef

98.

Seow-Chen F, Goh H, Eu K, Ho Y, Tay S (1993) A simple and effective treatment for hemorrhagic radiation proctopathy using formalin. Dis Colon Rectum 36(2):135–138. doi:10.1007/bf02051168 CrossRef

99.

Biswal B, Lal P, Rath G, Shukla N, Mohanti B, Deo S (1995) Intrarectal formalin application, an effective treatment for grade III haemorrhagic radiation proctitis. Radiother Oncol 35(3):212–215. doi:10.1016/0167-8140(95)01565-x PubMedCrossRef

100.

Saclarides T, King D, Franklin J, Doolas A (1996) Formalin installation for refractory radiation-induced hemorrhagic proctitis. Dis Colon Rectum 39(2):196–199. doi:10.1007/bf02068075 PubMedCrossRef

101.

Roche B, Chauterns R, Marti M (1996) Application of formaldehyde for treatment of hemorrhagic radiation-induced proctitis. World J Surg 20(8):1092–1095. doi:10.1007/s002689900166 PubMedCrossRef

102.

Counter S, Froese D, Hart M (1999) Prospective evaluation of formalin therapy for radiation proctitis. Am J Surg 177(5):396–398. doi:10.1016/s0002-9610(99)00072-0 PubMedCrossRef

103.

Luna-Pérez P, Rodríguez-Ramírez SE (2002) Formalin instillation for refractory radiation-induced hemorrhagic proctitis. J Surg Oncol 80(1):41–44. doi:10.1002/jso.10095 PubMedCrossRef

104.

de Parades V, Etienney I, Bauer P, Bourguignon J, Meary N, Mory B, Sultan S, Taouk M, Thomas C, Atienza P (2005) Formalin application in the treatment of chronic radiation-induced hemorrhagic proctitis—an effective but not risk-free procedure: a prospective study of 33 patients. Dis Colon Rectum 48(8):1535–1541. doi:10.1007/s10350-005-0030-z PubMedCrossRef

105.

Raman RR (2007) Two percent formalin retention enemas for hemorrhagic radiation proctitis: a preliminary report. Dis Colon Rectum 50(7):1032–1039. doi:10.1007/s10350-007-0241-6 PubMedCrossRef

106.

Sharma B, Kumar R, Singh KK, Chauhan V (2010) Intrarectal application of formalin for chronic radiation proctitis: a simple, cheap and effective treatment. Trop Gastroenterol 31(1):37–40PubMed

107.

Nelamangala Ramakrishnaiah VP, Javali TD, Dharanipragada K, Reddy KS, Krishnamachari S (2012) Formalin dab, the effective way of treating haemorrhagic radiation proctitis: a randomized trial from a tertiary care hospital in South India. Color Dis 14(7):876–882. doi:10.1111/j.1463-1318.2012.03008.x CrossRef

108.

Sánchez HA, del Vicente Sánchez MP, Arteta Jiménez M (2012) Formalin for haemorrhagic radiation-induced proctitis. Int J Color Dis 27(5):683–685. doi:10.1007/s00384-011-1268-7 CrossRef

109.

Pironi D, Panarese A, Vendettuoli M, Pontone S, Candioli S, Manigrasso A, De Cristofaro F, Filippini A (2013) Chronic radiation-induced proctitis: the 4 % formalin application as non-surgical treatment. Int J Color Dis 28(2):261–266. doi:10.1007/s00384-012-1571-y

110.

Pikarsky AJ, Belin B, Efron J, Weiss EG, Nogueras JJ, Wexner SD (2000) Complications following formalin installation in the treatment of radiation-induced proctitis. Int J Color Dis 15(2):96–99. doi:10.1007/s003840050240 CrossRef

111.

Yeoh E, Tam W, Schoeman M, Moore J, Thomas M, Botten R, Di Matteo A (2013) Argon plasma coagulation therapy versus topical formalin for intractable rectal bleeding and anorectal dysfunction after radiation therapy for prostate carcinoma. Int J Radiat Oncol Biol Phys 87(5):954–959. doi:10.1016/j.ijrobp.2013.08.034 PubMedCrossRef

112.

Alfadhli AA, Alazmi WM, Ponich T, Howard JM, Prokopiw I, Alaqeel A, Gregor JC (2008) Efficacy of argon plasma coagulation compared with topical formalin application for chronic radiation proctopathy. Can J Gastroenterol 22(2):129–132PubMedCentralPubMed

113.

De Palma GD (2009) Confocal laser endomicroscopy in the “in vivo” histological diagnosis of the gastrointestinal tract. World J Gastroenterol 15(46):5770–5775. doi:10.3748/wjg.15.5770 PubMedCentralPubMedCrossRef

114.

Taylor JG, Disario JA, Bjorkman DJ (2000) KTP laser therapy for bleeding from chronic radiation proctopathy. Gastrointest Endosc 52(4):353–357. doi:10.1067/mge.2000.107726 PubMedCrossRef

115.

Do NL, Nagle D, Poylin VY (2011) Radiation proctitis: current strategies in management. Gastroenterol Res Pract 2011:1–9. doi:10.1155/2011/917941 CrossRef

116.

Lucarotti M, Mountford R, Bartolo D (1991) Surgical management of intestinal radiation injury. Dis Colon Rectum 34(10):865–869. doi:10.1007/bf02049698 PubMedCrossRef

117.

Yegappan M, Ho YH, Nyam D, Leong A, Eu KW, Seow C (1998) The surgical management of colorectal complications from irradiation for carcinoma of the cervix. Ann Acad Med Singap 27(5):627–630PubMed

118.

Fischer L, Kimose HH, Spjeldnaes N, Wara P (1990) Late progress of radiation-induced proctitis. Acta Chir Scand 156(11–12):801–805PubMed

119.

Lane BR, Stein DE, Remzi FH, Strong SA, Fazio VW, Angermeier KW (2006) Management of radiotherapy induced rectourethral fistula. J Urol 175(4):1382–1387PubMedCrossRef

120.

Turina M, Mulhall AM, Mahid SS, Yashar C, Galandiuk S (2008) Frequency and surgical management of chronic complications related to pelvic radiation. Arch Surg 143(1):46–52. doi:10.1001/archsurg.2007.7 PubMedCrossRef

Title: Chronic radiation proctitis: tricks to prevent and treat
Authors: Ben G. L. Vanneste
Lien Van De Voorde
Rogier J. de Ridder
Evert J. Van Limbergen
Philippe Lambin
Emile N. van Lin
Publication date: 01-10-2015
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 10/2015
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-015-2289-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Chronic radiation proctitis: tricks to prevent and treat

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2015

Negative surgical margin improved long-term survival of colorectal cancer liver metastases after hepatic resection: a systematic review and meta-analysis

Life-threatening hematochezia from a rectal venous malformation successfully treated with microfoam sclerotherapy: description of a new technique

In reply to Tin et al.

Effect of preoperative colonoscopic tattooing on lymph node harvest in T1 colorectal cancer

Colonic intussusception after endoscopic volvulus decompression

Mucinous anal adenocarcinoma invading the perianal region