Long-Term Results on the Efficacy of Argon Plasma Coagulation for Patients with Chronic Radiation Proctitis after Conventionally Fractionated, Dose-Escalated Radiotherapy for Prostate Cancer

Publication date: Available online 1 August 2016
Source:Practical Radiation Oncology
Author(s): Joseph Weiner, David Schwartz, Manuel Martinez, Joseph Safdieh, Ayse Aytaman, David Schreiber
PurposeTo assess the efficacy and outcomes of argon plasma coagulation in the management of chronic radiation proctitis after conventionally fractionated, dose-escalated radiation therapy (≥7560cGy).Methods and Materials.We retrospectively reviewed the charts on all patients treated with external beam radiation therapy (minimum dose 7560cGy) for histologically confirmed prostate cancer at our institution from 2003 to 2011. Five hundred patients met these criteria and of these 35 patients (7.0%) developed radiation proctitis necessitating intervention with APC. Indications for APC treatment were either the need for blood transfusions due to proctitis-related anemia or refractory bleeding despite medical management.ResultsThe median follow up from the completion of radiation treatment was 78months (range 19–129) and the median follow up from the most recent APC treatment was 56months (range 3–112). Fifteen men (42.9%) needed blood transfusions due to proctitis related anemia. For 19 patients (54.3%), bleeding was controlled after one or two treatments. Eventual bleeding control was obtained in 30 patients (85.7%). The median number of sessions per patient was 2 (range 1–13). Post-APC ulceration was noted in 8 cases (22.9%). Two patients (5.7%) developed colovesicular fistulas, with one patient dying from this complication. Short interval between treatments (≤35days) was associated with an increased risk of ulcer or fistula formation.ConclusionsAPC is an effective treatment for patients with medically refractive radiation proctitis after dose-escalated radiotherapy, frequently controlling bleeding after only one or two sessions. However, rectal ulceration is a common complication, along with a small risk of life-threatening toxicity.



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