JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

Table of Contents

2019 Month : August Volume : 6 Issue : 31 Page : 2121-2125

CHRONIC RADIATION PROCTITIS- A COMMON BUT DIFFICULT PROBLEM

Dipankar Ray1

Corresponding Author:
Dr. Dipankar Ray,
Flat No. 1A/2, Anupama Housing Complex,
(Phase 1), VIP Road, Kolkata- 700052,
West Bengal.
E-mail: dray3453@yahoo.co.in
DOI: 10.18410/jebmh/2019/432

ABSTRACT
BACKGROUND
Pelvic radiation is increasingly being used for management of genitourinary and lower gastrointestinal malignancies. Radiation induced damage to rectum, colon can present as acute radiation proctitis or chronic radiation proctitis (CRP), which presents months later. In South East Asia including India, cancer cervix is very commonly treated by radiotherapy. Rectal complications are quite common in these cases. Pain, irregular bowel and most important bleeding which leads to anaemia- these make quality of life very poor for these patients. Diagnosis is confirmed by endoscopy. Management of CRP is also not standardized. Endoscopic, non-endoscopic, surgical- all have roles in management of this condition.

METHODS
Since 2010 to 2014 we have treated 40 patients of chronic haemorrhagic radiation proctitis in Medical College Kolkata. All had radiotherapy for carcinoma cervix. Patients were assessed clinically as well as endoscopically. Mild to moderated disease were treated with Sucralfate enema. Severe or refractory haemorrhagic proctocolitis was treated with low volume formalin instillation via sigmoidoscope. End point of treatment was cessation of bleeding, stable haemoglobin 10 gm% without blood transfusion.

RESULTS
Mean age found to be 66 years and 60% patients presented within one year of finishing radiotherapy. 33 patients (82%) presented with rectal involvement only and 29 patients (72%) had endoscopic grading 2 -3. 26 patients (65%) improved after one installation of 4% formalin and only 10 patients needed more than two instillations.

CONCLUSIONS
Chronic haemorrhagic radiation proctitis is a common side effect of pelvic radiation. Prevention is desirable. Control of bleeding is a difficult problem. Drugs, topical application including formalin instillation, Argon plasma coagulation, RFA, laser all are effective treatment options keeping surgery reserved for complications like stricture or fistula. Our experience of low volume 4% formalin instillation is very effective.

KEYWORDS
Radiotherapy, Complications, Chronic Radiation Proctitis