Argon plasma coagulation therapy in hemorrhagic radiation proctitis following pelvic radiation in gynecological malignancies.

Abstract

Introduction:

Chronic radiation proctitis is a common chronic complication of malignant pelvic diseases after pelvic radiation therapy. Although, the incidence has decreased after advent of intensity-modulated radiotherapy due to better control of radiation dose to rectum. In the era of conventional two-field radiotherapy to pelvis, this was a common complication usually presenting after 1-2 years of treatment completion. Rectal bleeding caused by radiation proctitis is difficult to manage. Argon plasma coagulation (APC) is an electrocoagulation technique that appears to be an effective and low-cost alternative to the use of lasers in gastrointestinal endoscopy. The aim of this study was to evaluate the efficacy of APC, as well as patients' tolerance of the procedure, in the treatment of bleeding radiation-induced proctitis.

Materials and Methods:

Between January 2015 and August 2017, 29 patients of cancer cervix treated with definite radiotherapy both external and brachytherapy who suffered from rectal bleeding due to radiation proctitis were included for treatment with argon plasma laser (APC). Twenty-three patients suffered from anemia, 16 of whom required blood transfusion. APC was performed, applying the no-touch spotting technique at an electrical power of 40 Watt and an argon gas flow of 1.5-2.0 l/min. Pulse duration was <0.5 s. Treatment sessions were carried out at intervals of 3 weeks. Subjects received 2-4 treatment sessions.

Results:

Twenty-eight out of 29 patients were accessible for effects and results. APC led to persistent clinical and endoscopic remission of rectal bleeding after a median of three sessions. No adverse effects were encountered after initial treatment. All the patients were in complete remission.

Conclusions:

APC is an effective, safe, and well-tolerated treatment for rectal bleeding caused by chronic radiation proctitis. It should be considered as a first-line therapy for radiation proctitis.

• Authors: Neeraj Jain, Jerath Amitabh Mohan, Sharma Ramita, Sachdeva Kanchan, Kaur Amandeep, Sudan Meena
• Journal: Journal of cancer research and therapeutics (J Cancer Res Ther) 2023 Apr-Jun Vol. 19 Issue 3 Pg. 708-712 ISSN: 1998-4138 [Electronic] India
• PMID: 37470598 (Publication Type: Journal Article)

Chemical References

• Argon

Topics

• Female
• Humans
• Rectum (pathology)
• Argon Plasma Coagulation (adverse effects)
• Genital Neoplasms, Female (complications)
• Proctitis (therapy, drug therapy)
• Gastrointestinal Hemorrhage (etiology, therapy)
• Radiation Injuries (therapy, complications)
• Argon (therapeutic use)
• Treatment Outcome