Chronic Radiation Proctitis: Tricks to Prevent and Treat

Overview

Journal Int J Colorectal Dis

Specialties Gastroenterology
General Surgery

Date 2015 Jul 23

PMID 26198994

Citations 39

Authors

Ben G L Vanneste

Lien Van De Voorde

Rogier J de Ridder

Evert J Van Limbergen

Philippe Lambin

Emile N van Lin

Affiliations

Soon will be listed here.

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.

Citing Articles

The Impact of Radiation Proctopathy on Secondary-Primary Colorectal Cancer in Patients with Prostate Cancer.

Ahmad A, Ansari Z, Jamal Al-Din T, Channagiri R, Khan O, Castro F J Gastrointest Cancer. 2025; 56(1):66.

PMID: 39954024 PMC: 11829924. DOI: 10.1007/s12029-025-01193-0.

Radiation Proctitis: A Review of Pathophysiology and Treatment Strategies.

Bhatia M, Suliman H, Ahmed R, Kostadinov D, Singhal T Cureus. 2024; 16(9):e70581.

PMID: 39483948 PMC: 11525059. DOI: 10.7759/cureus.70581.

Prevention and management of radiotherapy-related toxicities in gynecological malignancies. Position paper on behalf of AIRO (Italian Association of Radiotherapy and Clinical Oncology).

Perrucci E, Macchia G, Cerrotta A, Andrulli A, Autorino R, Barcellini A Radiol Med. 2024; 129(9):1329-1351.

PMID: 39198369 PMC: 11379782. DOI: 10.1007/s11547-024-01844-5.

Start Early and See Inflammatory; Late, Nothing Save RAVE: How to Appreciate Radiation Proctitis as a Continuum.

Tobi M, Bradley I, Moole S, Talwar H, McVicker B, Kintanar E Gastro Hep Adv. 2024; 2(3):362-369.

PMID: 39132647 PMC: 11308657. DOI: 10.1016/j.gastha.2022.11.001.

A unified strategy to focal brachytherapy incorporating transperineal biopsy, image fusion, and real-time implantation with and without rectal spacer simulated in prostate phantoms.

Vanneste B, Skouteris B, Pinheiro L, Voncken R, Van Limbergen E, Lutgens L J Contemp Brachytherapy. 2024; 16(2):139-149.

PMID: 38808209 PMC: 11129653. DOI: 10.5114/jcb.2024.139280.

References

Seow-Choen F, Goh H, Eu K, Ho Y, Tay S . A simple and effective treatment for hemorrhagic radiation proctitis using formalin. Dis Colon Rectum. 1993; 36(2):135-8. DOI: 10.1007/BF02051168. View

West C, Barnett G . Genetics and genomics of radiotherapy toxicity: towards prediction. Genome Med. 2011; 3(8):52. PMC: 3238178. DOI: 10.1186/gm268. View

Nascimento M, Aguilar-Nascimento J, Caporossi C, Michelon Castro-Barcellos H, Teixeira Motta R . 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. 2014; 90(2):289-95. DOI: 10.1016/j.ijrobp.2014.05.049. View

Valdagni R, Rancati T, Fiorino C, Fellin G, Magli A, Baccolini M . Development of a set of nomograms to predict acute lower gastrointestinal toxicity for prostate cancer 3D-CRT. Int J Radiat Oncol Biol Phys. 2008; 71(4):1065-73. DOI: 10.1016/j.ijrobp.2007.11.037. View

Villavicencio R, Rex D, Rahmani E . Efficacy and complications of argon plasma coagulation for hematochezia related to radiation proctopathy. Gastrointest Endosc. 2002; 55(1):70-4. DOI: 10.1067/mge.2002.119877. View

van Lin E, Kristinsson J, Philippens M, de Jong D, van der Vight L, Kaanders J . 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. 2006; 67(3):799-811. DOI: 10.1016/j.ijrobp.2006.09.034. View

Szabo S, Vattay P, Scarbrough E, Folkman J . Role of vascular factors, including angiogenesis, in the mechanisms of action of sucralfate. Am J Med. 1991; 91(2A):158S-160S. DOI: 10.1016/0002-9343(91)90469-e. View

Ben Soussan E, Mathieu N, Roque I, Antonietti M . Bowel explosion with colonic perforation during argon plasma coagulation for hemorrhagic radiation-induced proctitis. Gastrointest Endosc. 2003; 57(3):412-3. DOI: 10.1067/mge.2003.131. View

Song D, Herfarth K, Uhl M, Eble M, Pinkawa M, van Triest B . 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. 2013; 87(1):81-7. PMC: 3737267. DOI: 10.1016/j.ijrobp.2012.12.019. View

10.

Swan M, Moore G, Sievert W, Devonshire D . Efficacy and safety of single-session argon plasma coagulation in the management of chronic radiation proctitis. Gastrointest Endosc. 2010; 72(1):150-4. DOI: 10.1016/j.gie.2010.01.065. View

11.

Fenwick J, Khoo V, Nahum A, Sanchez-Nieto B, Dearnaley D . 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. 2001; 49(2):473-80. DOI: 10.1016/s0360-3016(00)01496-6. View

12.

Andreyev H, Benton B, Lalji A, Norton C, Mohammed K, Gage H . Algorithm-based management of patients with gastrointestinal symptoms in patients after pelvic radiation treatment (ORBIT): a randomised controlled trial. Lancet. 2013; 382(9910):2084-92. DOI: 10.1016/S0140-6736(13)61648-7. View

13.

Shadad A, Sullivan F, Martin J, Egan L . Gastrointestinal radiation injury: symptoms, risk factors and mechanisms. World J Gastroenterol. 2013; 19(2):185-98. PMC: 3547560. DOI: 10.3748/wjg.v19.i2.185. View

14.

Schutzer M, Orio P, Biagioli M, Asher D, Lomas H, Moghanaki D . A review of rectal toxicity following permanent low dose-rate prostate brachytherapy and the potential value of biodegradable rectal spacers. Prostate Cancer Prostatic Dis. 2015; 18(2):96-103. DOI: 10.1038/pcan.2015.4. View

15.

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

16.

Turina M, Mulhall A, Mahid S, Yashar C, Galandiuk S . Frequency and surgical management of chronic complications related to pelvic radiation. Arch Surg. 2008; 143(1):46-52. DOI: 10.1001/archsurg.2007.7. View

17.

Wachter S, Gerstner N, Goldner G, Potzi R, Wambersie A, Potter R . Endoscopic scoring of late rectal mucosal damage after conformal radiotherapy for prostatic carcinoma. Radiother Oncol. 2000; 54(1):11-9. DOI: 10.1016/s0167-8140(99)00173-5. View

18.

de Parades V, Etienney I, Bauer P, Bourguignon J, Meary N, Mory B . 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. 2005; 48(8):1535-41. DOI: 10.1007/s10350-005-0030-z. View

19.

Krol R, Smeenk R, van Lin E, Yeoh E, Hopman W . Systematic review: anal and rectal changes after radiotherapy for prostate cancer. Int J Colorectal Dis. 2013; 29(3):273-83. DOI: 10.1007/s00384-013-1784-8. View

20.

Rotondano G, Bianco M, Marmo R, Piscopo R, Cipolletta L . Long-term outcome of argon plasma coagulation therapy for bleeding caused by chronic radiation proctopathy. Dig Liver Dis. 2003; 35(11):806-10. DOI: 10.1016/s1590-8658(03)00454-7. View