ABSTRACT
BACKGROUND: Chronic radiation proctitis (CRP) manifests as rectal bleeding 12 to 24 months after pelvic radiotherapy. No criterion standard of treatment has been established, although argon plasma coagulation (APC) has increasingly become the treatment of choice. Previous studies have applied APC over multiple sessions, necessitating increased numbers of treatments. OBJECTIVE: To assess the safety and efficacy of large-volume APC application in the treatment of CRP with the intention of a single-session treatment protocol. DESIGN: Prospective study. SETTING: Tertiary referral hospital. PATIENTS: Over an 8-year period, consecutive patients with CRP with rectal bleeding were prospectively enrolled. INTERVENTION: Large-volume APC application to affected rectal mucosa. MAIN OUTCOME MEASUREMENTS: Number of treatments, bleeding scores, complications. RESULTS: Fifty patients (mean age 72.1 years; range 51-87 years) were treated; 45 were men (prostate cancer). The mean period between radiotherapy and initial APC treatment was 23 months (range 4-140 months). Seventeen (34%) patients had grade A endoscopic severity, 23 (46%) grade B, and 10 (20%) grade C. Other therapies failed in 16 (32%) patients. The mean number of treatments was 1.36 (range 1-3) with a mean follow-up of 20.6 months (range 6-48 months). Sixty-eight percent of patients were successfully treated after 1 session and 96% after 2 sessions. Bleeding scores improved in all patients (P < .001). Seventeen (34%) patients experienced short-term, self-limiting complications; 1 (2%) patient experienced a long-term complication. LIMITATIONS: Nonrandomized study. CONCLUSIONS: Large-volume APC treatment was successful in the treatment of CRP, including those in whom other therapies had previously failed, and resulted in a decreased number of treatments compared with other published studies. The benefits were offset by an increased incidence of short-term complications but no increase in long-term complications.
