MANAGEMENT OF CHRONIC RADIATION PROCTOPATHY: A SINGLE CENTRE 12 YEARS’ EXPERIENCE WITH ARGON PLASMA COAGULATION

Aims Chronic radiation proctopathy (CRP) is a recognised complication of pelvic radiotherapy, but no standard treatment has been established. The aims of this study were to define the natural history of CRP and to evaluate and compare efficacy of chosen therapies.

Methods Single centre retrospective cohort study including consecutive patients with endoscopically confirmed CRP between January 2008 and October 2019. Data were collected from electronic medical reports. Clinical success was defined as a significant reduction or cessation of rectal bleeding. Endoscopic therapy performed was argon plasma coagulation (APC).

Results A total of 231 patients were included (male: 125 (54.1%); median age: 76 (66-80) years. Most common tumours were prostate (47.0%) and cervical (39.1%). Diagnosis was made in a median of 2 (1-3) years after radiotherapy. The most common presenting symptom was rectal bleeding (77.1%) and 19.9% of patients were asymptomatic. Antithrombotic therapy was associated with the report of more symptoms (94.8% vs. 73.1%, p< 0.05) without significant differences in haemoglobin value (12.2g/dL vs. 12.7g/dL, p=0.08). In 36.8% of patients no treatment was required, 9.0% received exclusively medical therapy (with a clinical success of 30%), 54.1% received solely APC and 16.9% received both therapies. A median of 1.7 (1.0-2.0) APC sessions was performed and the median time interval between sessions was 1.5 (0.5-3.0) months. Clinical success was documented in 97.6% of cases. Combined medical and endoscopic treatment was associated with a significantly lower number of sessions (1.0 vs. 2.0, p< 0.01). The number of sessions wasn’t significantly different between antithrombotic users and non-users (1.0 vs.1.0, p=0.50). No adverse events were documented.

Conclusions Two-thirds CRP patients will require treatment and APC is an effective and safe endoscopic therapy. Nevertheless, a significant number of cases will not require intervention. Indications and clinically relevant endpoints for endoscopic therapy need to be well-defined.