Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T12:02:27.312Z Has data issue: false hasContentIssue false
  • English
  • Français

Radiation induced-late bowel toxicity: role of argon plasma coagulation

Published online by Cambridge University Press:  05 August 2011

Samy M. Al Gizawy ,
Laila Abdelbaki  and
Nahed A. Makhlouf
Samy M. Al Gizawy*
Affiliation:
Department of Clinical Oncology, Faculty of Medicine, Assiut University, Assiut, Egypt
Laila Abdelbaki
Affiliation:
Department of Tropical Medicine & Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
Nahed A. Makhlouf
Affiliation:
Department of Tropical Medicine & Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
*
Correspondence to: Samy M. Al Gizawy, MD PhD, Faculty of Medicine, Assiut University, Department of Clinical Oncology, 71111Assiut, Egypt. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose: The purpose of this study was to identify predictors and treatment outcome of late bowel toxicity after three dimensional pelvic radiotherapy for genitourinary malignancies and also to describe our experience with Argon Plasma Coagulation (APC) in this toxicity.

Patients and methods: Between March 2004 and March 2010, all patients who had completed a course of pelvic radiotherapy for genitourinary malignancies at our Institute were enrolled in this study. Every patient with lower GI symptoms underwent sigmoidoscopy and accordingly, some patients were subjected to intervention by APC.

Results: One hundred and thirty-six patients met all inclusion criteria. Median FU period was 37 months. Chronic diarrhoea was scored as Grade 1 or 2 in 35 patients (25.7%). Chronic proctitis was scored as Grade 1 or 2 in 17 patients (12.5%) and Grade 3 in 6 patients (4.4%), 25 patients developed chronic bleeding per rectum, 16 (11.8%) were Grade 1 or 2, while 9 patients (6.6%) were Grade 3. Both maximum rectal dose and comorbidity ≥1 significantly correlated with the development of chronic proctitis (p = 0.040 for both).

Endoscopic findings showed mucosal injury in 59 cases (84.29%) and vascular injury in 42 patients (60%). APC was successful in controlling bleeding and other symptoms in 14 cases (82.4%) and 16 cases (70%) respectively.

Conclusion: Three dimensional pelvic radiotherapy using two-phase technique is associated with a low level of Grade 3 late lower gastrointestinal toxicities. The most common presenting symptom is chronic diarrhoea. Both maximum rectal dose and comorbidity ≥1 significantly predict the development of chronic proctitis. APC is an effective, safe and well-tolerated treatment for chronic radiation proctitis.

Keywords

Radiationlate bowel toxicityargon plasma coagulation
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 11 , Issue 2 , June 2012 , pp. 92 - 100
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0, DCTD, NCI, NIH, DHHS. March 31, 2003. (http://ctep.cancer.gov), Publish Date: August 9, 2006.Google Scholar
Gami, B, Harrington, K, Blake, Pet al. How patients manage gastrointestinal symptoms after pelvic radiotherapy. Aliment Pharmacol Ther 2003; 18:987–994.CrossRefGoogle ScholarPubMed
Potosky, AL, Legler, J, Albertsen, PCet al. Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the Prostate Cancer Outcomes Study. J Natl Cancer Inst 2000; 92:1582–1592.CrossRefGoogle ScholarPubMed
Andreyev, HJN, Amin, Z, Blake, P, Dearnaley, D, Tait, D, Vlavianos, P. GI symptoms developing after pelvic radiotherapy require gastroenterological review. Gut 2003; 52(Suppl. 1):A90.Google Scholar
Andreyev, J. Gastrointestinal complications of pelvic radiotherapy: are they of any importance? Gut 2005; 54:1051–1054.CrossRefGoogle ScholarPubMed
Zhou, C, Adler, DC, Becker, Let al. Effective treatment of chronic radiation proctitis using radiofrequency ablation. Therap Adv Gastroenterol 2009; 2:149–156.CrossRefGoogle ScholarPubMed
Henson, C. Chronic radiation proctitis: issues surrounding delayed bowel dysfunction post-pelvic radiotherapy and an update on medical treatment. Therap Adv Gastroenterol 2010; 3:359–365.CrossRefGoogle Scholar
Wedlake, LJ, Thomas, K, Lalji, A, Blake, P, Khoo, VS, Tait, D, Andreyev, HJ. Predicting late effects of pelvic radiotherapy: is there a better approach? Int J Radiat Oncol Biol Phys. 2010; 78:1163–1170.CrossRefGoogle ScholarPubMed
Haddock, Michael G.Sloan, Jeff A.Bollinger, John W.et al. Patient Assessment of Bowel Function During and After Pelvic Radiotherapy: Results of a Prospective Phase III North Central Cancer Treatment Group Clinical Trial. J Clin Oncol 2007; 25:1255–1259.CrossRefGoogle ScholarPubMed
Williams, HR, Vlavianos, P, Blake, Pet al. The significance of rectal bleeding after pelvic radiotherapy. Aliment Pharmacol Ther 2005; 21:1085–1090.CrossRefGoogle ScholarPubMed
Buchi, K. Radiation proctitis: therapy and prognosis. JAMA 1991; 265:1180.CrossRefGoogle ScholarPubMed
Cho, KH, Lee, CK, Levitt, SH. Proctitis after conventional external radiation therapy for prostate cancer: importance of minimizing posterior rectal dose. Radiology 1995; 195:699–703.CrossRefGoogle ScholarPubMed
Wong, MT, Lim, JF, Ho, KSet al. Radiation proctitis: a decade’s experience. Singapore Med J 2010; 51:315–319.Google ScholarPubMed
Michalski, JM, Gay, H, Jackson, A, Tucker, SL, Deasy, JO. Radiation dose-volume effects in radiation-induced rectal injury. Int J Radiat Oncol Biol Phys 2010; 76:S123–S129.CrossRefGoogle ScholarPubMed
Koper, PC, Heemsbergen, WD, Hoogeman, MSet al. Impact of volume and location of irradiated rectum wall on rectal blood loss after radiotherapy of prostate cancer. Int J Radiat Oncol Biol Phys 2004; 58:1072–1082.CrossRefGoogle ScholarPubMed
Fiorino, C, Sanguineti, G, Cozzarini, Cet al. Rectal dose-volume constraints in high-dose radiotherapy of localized prostate cancer. Int J Radiat Oncol Biol Phys 2003; 57:953–962.CrossRefGoogle ScholarPubMed
Schultheiss, TE, Lee, WR, Hunt, MAet al. Late GI and GU complications in the treatment of prostate cancer. Int J Radiat Oncol Biol Phys 1997; 37:3–11.CrossRefGoogle ScholarPubMed
Lim, G, Lau, H, Brasher, P. Factors influencing late rectal toxicity after radical radiotherapy of localized and locally advanced prostate cancer. Cancer Ther 2007; 5:253–260.Google Scholar
Skwarchuk, MW, Jackson, A, Zelefsky, MJet al. Late rectal toxicity after conformal radiotherapy of prostate cancer (I): multivariate analysis and dose-response. Int J Radiat Oncol Biol Phys 2000; 47:103–113.CrossRefGoogle ScholarPubMed
Seow-Choen, F, Goh, HS, Eu, KW, Ho, YH, Tay, SK. A simple and effective treatment for hemorrhagic radiation proctitis using formalin. Dis Colon Rectum 1993; 36:135–138.CrossRefGoogle ScholarPubMed
Kaassis, M, Oberti, E, Burtin, P, Boyer, J. Argon plasma coagulation for the treatment of hemorrhagic radiation proctitis. Endoscopy 2000; 32:673–676.CrossRefGoogle ScholarPubMed