Radiation proctitis is a late effect of pelvic radiotherapy – which is commonly used to treat prostate cancer and female pelvic malignancy – and causes rectal bleeding, anaemia, diarrhoea and incontinence. Rectal bleeding post radiotherapy causes worry about bowel cancer and symptoms can force patients to become house bound with increased anxiety. Topical therapy with formaldehyde and argon plasma coagulation (APC) is time consuming and formaldehyde can damage healthy tissue (Andreyev HJN et al 2015). Radiofrequency ablation (RFA) can be used to treat large areas of neovascularisation (Zhou et. al. 2009). We treated a large cohort with symptomatic rectal bleeding to evaluate if ablative endotherapy is effective in treating anaemia in radiation induced proctitis.Methods
A retrospective review of 37 consecutive male patients treated for rectal bleeding from radiation proctitis were identified; their haemoglobin before and after therapy was used. Those who were anaemic (Hb <130 g/dl) were further analysed to see if haemoglobin improved after endotherapy.Methods
Endoscopic therapy was delivered with either APC (ERBE) or RFA (HALO, Medtronic). Large areas were treated with RFA and smaller areas with APC. RFA probes are much more expensive than APC probes. Endoscopic therapy was repeated on an outpatient basis at 3–4 monthly intervals until all vessels were ablated or the patient was asymptomatic.Results
Small areas were treated with APC, RFA was used for APC treatment failure, heavy bleeding requiring transfusion iron therapy, or intolerable bleeding.Results
37 patient’s results showed an average increase in haemoglobin by 20.9 g/dL, a rise of 17.58%. Sub-group analysis looked 23 who were anaemic before the start of therapy and after treatment (Hb <130 g/dL), mean follow up was 8.97±1.5 months (range 1–38).Results
No side effects were noted. No clinically significant stricturing was experienced.Discussion
Endoscopic ablative therapy increases haemoglobin in patients with radiotherapy induced neovascularisation. Improvement is most marked in those who are anaemic with a 30% increase in haemoglobin. Reversing anaemia removes the need for ongoing iron therapy or blood transfusions, as well as increasing patient’s wellbeing. Reducing or stopping bleeding as evidenced with a sustained reversal of anaemia, will increase quality of life.Discussion
We have used a pragmatic approach of combining RFA and APC to maximise treatment area and limiting therapy costs. There were no long term complications, although patients may experience a slight increase in bleeding in the initial 24–48 hours post-therapy. Treatment seems to be enduring with the reversal of anaemia being maintained for a mean of 8.97 months and up to 38 months.