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Published in: International Journal of Colorectal Disease 2/2013

01-02-2013 | Original Article

Chronic radiation-induced proctitis: the 4 % formalin application as non-surgical treatment

Authors: Daniele Pironi, Alessandra Panarese, Maurizio Vendettuoli, Stefano Pontone, Salvatore Candioli, Annarita Manigrasso, Flaminia De Cristofaro, Angelo Filippini

Published in: International Journal of Colorectal Disease | Issue 2/2013

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Abstract

Purpose

Radiation proctitis is a known complication following radiation therapy for pelvic malignancy. The majority of cases are treated nonsurgically. Rectal instillation of formalin solution has been described as a successful treatment for chronic radiation-induced hemorrhagic proctitis resistant to medical treatment. We present our results in patients undergoing treatment with application of 4 % formalin for radiation-induced injury to the rectum.

Methods

All patients were treated under anesthesia by direct application of 4 % formalin solution to the affected rectal areas. Patient gender, initial malignancy, grade of proctitis, need for blood transfusion, previous therapy, number of applications and response to treatment with formalin, complications, and length of follow-up were reviewed.

Results

A total of 15 patients with a mean age of 68.9 (range, 48–77) years were followed for 31.3 (range, 18–51) months. The mean interval from the conclusion of radiotherapy and the onset of symptoms was 6.9 months. The mean duration of hemorrhagic proctitis before formalin application was 7.9 months. Ten patients had only one formalin application and five patients required a second application because of the persistent bleeding. Thirteen patients (87 %) had complete cessation of bleeding. No complications related to the formalin treatment were observed.

Conclusions

According to a revision of the literature and our experience, despite the small number of patients in our trial, we can state that the application of 4 % formalin solution is an effective, safe, and well-tolerated treatment for chronic radiation-induced hemorrhagic proctitis with minimal discomfort and no severe complications.
Literature
1.
go back to reference 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):213–217PubMedCrossRef 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):213–217PubMedCrossRef
2.
go back to reference Hong JJ, Park W, Ehrenpreis ED (2001) Review article: current therapeutic options for radiation proctopathy. Aliment Pharmacol Ther 15(9):1253–1262, ReviewPubMedCrossRef Hong JJ, Park W, Ehrenpreis ED (2001) Review article: current therapeutic options for radiation proctopathy. Aliment Pharmacol Ther 15(9):1253–1262, ReviewPubMedCrossRef
3.
go back to reference Lee SI, Park YA, Sohn SK (2007) Formalin application for the treatment of radiation-induced hemorrhagic proctitis. Yonsei Med J 48(1):97–100PubMedCrossRef Lee SI, Park YA, Sohn SK (2007) Formalin application for the treatment of radiation-induced hemorrhagic proctitis. Yonsei Med J 48(1):97–100PubMedCrossRef
4.
go back to reference 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):1535–1541PubMedCrossRef 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):1535–1541PubMedCrossRef
5.
go back to reference Wong MT, Lim JF, Ho KS, Ooi BS, Tang CL, Eu KW (2010) Radiation proctitis: a decade's experience. Singapore Med J 51(4):315–319PubMed Wong MT, Lim JF, Ho KS, Ooi BS, Tang CL, Eu KW (2010) Radiation proctitis: a decade's experience. Singapore Med J 51(4):315–319PubMed
6.
go back to reference Konishi T, Watanabe T, Nagawa H (2006) Formalin application in the treatment of chronic radiation-induced hemorrhagic proctitis induces acute deterioration of mucosal blood flow. Dis Colon Rectum 49(4):530–531PubMedCrossRef Konishi T, Watanabe T, Nagawa H (2006) Formalin application in the treatment of chronic radiation-induced hemorrhagic proctitis induces acute deterioration of mucosal blood flow. Dis Colon Rectum 49(4):530–531PubMedCrossRef
7.
go back to reference 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):596–600PubMedCrossRef 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):596–600PubMedCrossRef
8.
go back to reference Do NL, Nagle D, Poylin VY (2011) Radiation proctitis: current strategies in management. Gastroenterol Res Pract 2011:917941, Epub 2011 Nov 17PubMed Do NL, Nagle D, Poylin VY (2011) Radiation proctitis: current strategies in management. Gastroenterol Res Pract 2011:917941, Epub 2011 Nov 17PubMed
9.
go back to reference Hayne D, Vaizey CJ, Boulos PB (2001) Anorectal injury following pelvic radiotherapy. Br J Surg 88(8):1037–1048PubMedCrossRef Hayne D, Vaizey CJ, Boulos PB (2001) Anorectal injury following pelvic radiotherapy. Br J Surg 88(8):1037–1048PubMedCrossRef
10.
go back to reference Alfadhli AA, Alazmi WM, Ponich T, Howard JM, Prokopiw I, Alaqeel A, Gregor JC (2008) Efficacy of argon plasma coagulation compared to topical formalin application for chronic radiation proctopathy. Can J Gastroenterol 22(2):129–132PubMed Alfadhli AA, Alazmi WM, Ponich T, Howard JM, Prokopiw I, Alaqeel A, Gregor JC (2008) Efficacy of argon plasma coagulation compared to topical formalin application for chronic radiation proctopathy. Can J Gastroenterol 22(2):129–132PubMed
11.
go back to reference Denton AS, Andreyev HJ, Forbes A, Maher EJ (2002) Systematic review for non-surgical interventions for the management of late radiation proctitis. Br J Cancer 87(2):134–143, ReviewPubMedCrossRef Denton AS, Andreyev HJ, Forbes A, Maher EJ (2002) Systematic review for non-surgical interventions for the management of late radiation proctitis. Br J Cancer 87(2):134–143, ReviewPubMedCrossRef
12.
go back to reference Brown RB (1969) A method of management of inoperable carcinoma of the bladder. Med J Aust 1(1):23–24PubMed Brown RB (1969) A method of management of inoperable carcinoma of the bladder. Med J Aust 1(1):23–24PubMed
13.
go back to reference Rubinstein E, Ibsen T, Rasmussen RB, Reimer E, Sørensen BL (1986) Formalin treatment of radiation-induced hemorrhagic proctitis. Am J Gastroenterol 81(1):44–45PubMed Rubinstein E, Ibsen T, Rasmussen RB, Reimer E, Sørensen BL (1986) Formalin treatment of radiation-induced hemorrhagic proctitis. Am J Gastroenterol 81(1):44–45PubMed
14.
go back to reference Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213PubMedCrossRef Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213PubMedCrossRef
15.
go back to reference Hernández Sánchez A, Vicente Sánchez MD, Arteta Jiménez M (2011) Formalin for haemorrhagic radiation-induced proctitis. Int J Colorectal Dis 39(2):196–199 Hernández Sánchez A, Vicente Sánchez MD, Arteta Jiménez M (2011) Formalin for haemorrhagic radiation-induced proctitis. Int J Colorectal Dis 39(2):196–199
16.
go back to reference Johnston MJ, Robertson GM, Frizelle FA (2003) Management of late complications of pelvic radiation in the rectum and anus: a review. Dis Colon Rectum 46(2):247–259, ReviewPubMedCrossRef Johnston MJ, Robertson GM, Frizelle FA (2003) Management of late complications of pelvic radiation in the rectum and anus: a review. Dis Colon Rectum 46(2):247–259, ReviewPubMedCrossRef
17.
go back to reference Silva RA, Correia AJ, Dias LM, Viana HL, Viana RL (1999) Argon plasma coagulation therapy for hemorrhagic radiation proctosigmoiditis. Gastrointest Endosc 50(2):221–224PubMedCrossRef Silva RA, Correia AJ, Dias LM, Viana HL, Viana RL (1999) Argon plasma coagulation therapy for hemorrhagic radiation proctosigmoiditis. Gastrointest Endosc 50(2):221–224PubMedCrossRef
18.
go back to reference Chattopadhyay G, Ray D, Chakravartty S, Mandal S (2010) Formalin instillation for uncontrolled radiation induced haemorrhagic proctitis. Trop Gastroenterol 31(4):291–294PubMed Chattopadhyay G, Ray D, Chakravartty S, Mandal S (2010) Formalin instillation for uncontrolled radiation induced haemorrhagic proctitis. Trop Gastroenterol 31(4):291–294PubMed
19.
go back to reference Bem J, Bem S, Singh A (2000) Use of hyperbaric oxygen chamber in the management of radiation-related complications of the anorectal region: report of two cases and review of the literature. Dis Colon Rectum 43(10):1435–1438, ReviewPubMedCrossRef Bem J, Bem S, Singh A (2000) Use of hyperbaric oxygen chamber in the management of radiation-related complications of the anorectal region: report of two cases and review of the literature. Dis Colon Rectum 43(10):1435–1438, ReviewPubMedCrossRef
20.
go back to reference Shrom SH, Donaldson MH, Duckett JW, Wein AJ (1977) Formalin treatment for intractable hemorrhagic cystitis: a review of the literature with 16 additional cases. Surg Forum 28:565–567PubMed Shrom SH, Donaldson MH, Duckett JW, Wein AJ (1977) Formalin treatment for intractable hemorrhagic cystitis: a review of the literature with 16 additional cases. Surg Forum 28:565–567PubMed
21.
go back to reference Seow-Choen F, Goh HS, Eu KW, Ho YH, Tay SK (1993) A simple and effective treatment for hemorrhagic radiation proctitis using formalin. Dis Colon Rectum 36(2):135–138PubMedCrossRef Seow-Choen F, Goh HS, Eu KW, Ho YH, Tay SK (1993) A simple and effective treatment for hemorrhagic radiation proctitis using formalin. Dis Colon Rectum 36(2):135–138PubMedCrossRef
22.
go back to reference 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 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
23.
go back to reference Saclarides TJ, King DG, Franklin JL, Doolas A (1996) Formalin instillation for refractory radiation-induced hemorrhagic proctitis. Report of 16 patients. Dis Colon Rectum 39(2):196–199PubMedCrossRef Saclarides TJ, King DG, Franklin JL, Doolas A (1996) Formalin instillation for refractory radiation-induced hemorrhagic proctitis. Report of 16 patients. Dis Colon Rectum 39(2):196–199PubMedCrossRef
24.
go back to reference 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. Colorectal Dis 14(7):876–882. doi:10.1111/j.1463-1318.2012.03008.x PubMedCrossRef 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. Colorectal Dis 14(7):876–882. doi:10.​1111/​j.​1463-1318.​2012.​03008.​x PubMedCrossRef
Metadata
Title
Chronic radiation-induced proctitis: the 4 % formalin application as non-surgical treatment
Authors
Daniele Pironi
Alessandra Panarese
Maurizio Vendettuoli
Stefano Pontone
Salvatore Candioli
Annarita Manigrasso
Flaminia De Cristofaro
Angelo Filippini
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 2/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-012-1571-y

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