From the Guidelines
Radiation proctitis is a common complication of pelvic radiation therapy, characterized by inflammation and damage to the rectum, leading to symptoms such as rectal bleeding, diarrhea, and painful bowel movements.
Definition and Causes
Radiation proctitis occurs when radiation damages the cells lining the rectum, causing inflammation, bleeding, and tissue changes [ 1 ]. It can be acute, occurring during or shortly after treatment, or chronic, developing months or years after radiation therapy has ended. The condition is often seen in patients undergoing radiation therapy for cancers in the pelvic area, such as prostate, rectal, or gynecological cancers.
Symptoms and Diagnosis
Symptoms of radiation proctitis typically include rectal bleeding, diarrhea, painful bowel movements, increased urgency, and sometimes rectal discharge or incontinence [ 1 ]. Diagnosis is usually based on medical history, physical examination, and endoscopic evaluation.
Treatment and Management
Treatment depends on the severity of the condition and may include anti-inflammatory medications like mesalamine suppositories (1000mg daily), sucralfate enemas (10ml of 10% suspension twice daily), or oral sulfasalazine (1000mg twice daily) [ 1 ]. For bleeding, argon plasma coagulation performed during endoscopy is often effective [ 1 ]. Hyperbaric oxygen therapy (20-40 sessions at 2.0-2.4 atmospheres) may help severe cases by promoting tissue healing [ 1 ]. Lifestyle modifications like avoiding spicy foods, caffeine, and alcohol can reduce symptom flares.
Prevention and Risk Factors
Prevention of radiation proctitis involves minimizing radiation exposure to the rectum during radiation therapy [ 1 ]. Risk factors for radiation proctitis include large irradiated volume, high radiation dose, and older radiation techniques [ 1 ].
Key Points
- Radiation proctitis is a common complication of pelvic radiation therapy
- Symptoms include rectal bleeding, diarrhea, and painful bowel movements
- Treatment depends on severity and may include anti-inflammatory medications, argon plasma coagulation, and hyperbaric oxygen therapy
- Lifestyle modifications can help reduce symptom flares
- Prevention involves minimizing radiation exposure to the rectum during radiation therapy
From the Research
Definition of Radiation Proctitis
- Radiation proctitis is a complication of pelvic radiation therapy, characterized by damage to the rectal epithelium by secondary ionizing radiation 2.
- It can result in severe bleeding, chronic anemia, and other symptoms such as fecal urgency, incontinence, and stool frequency 3, 4.
Classification of Radiation Proctitis
- Radiation proctitis can be classified as acute or chronic, depending on the onset of signs and symptoms 2.
- Chronic radiation proctitis is a well-described complication of pelvic radiation therapy, and can result in severe bleeding that is refractory to conventional treatment 3.
Treatment Options for Radiation Proctitis
- Argon plasma coagulation (APC) is an effective treatment for hemorrhagic radiation proctitis, and can be used to stop bleeding and improve patient well-being 3, 4, 5.
- Sucralfate or placebo following APC can also be used to treat chronic radiation proctitis, although additional sucralfate treatment may not influence the clinical or endoscopic outcome 6.
- Other treatment options, such as topical steroids and 5-aminosalicylic acid, may be used, but are often ineffective in severe cases 3.
Complications and Prognosis of Radiation Proctitis
- Radiation proctitis can lead to complications such as rectal stenosis, and may require long-term follow-up supervision to evaluate the risk of these complications 3, 4.
- The prognosis for patients with radiation proctitis is generally good, with many patients experiencing significant improvement in symptoms and quality of life with treatment 3, 4, 5.