Brief Article
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World J Gastroenterol. Aug 14, 2013; 19(30): 4944-4949
Published online Aug 14, 2013. doi: 10.3748/wjg.v19.i30.4944
Treatment of hemorrhagic radiation-induced proctopathy with a 4% formalin application under perianal anesthetic infiltration
Narimantas Evaldas Samalavicius, Audrius Dulskas, Alfredas Kilius, Kestutis Petrulis, Darius Norkus, Arvydas Burneckis, Konstantinas Povilas Valuckas
Narimantas Evaldas Samalavicius, Center of Oncosurgery, Institute of Oncology, Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius University, LT-08406, Vilnius, Lithuania
Audrius Dulskas, Alfredas Kilius, Kestutis Petrulis, Center of Oncosurgery, Institute of Oncology, Vilnius University, LT-08406, Vilnius, Lithuania
Darius Norkus, Arvydas Burneckis, Konstantinas Povilas Valuckas, Radiotherapy and Drug Therapy Center, Institute of Oncology, Vilnius University, LT-08406, Vilnius, Lithuania
Author contributions: Samalavicius NE designed and conducted the study and performed the literature search; Dulskas A assisted in the literature search and wrote the paper; Kilius A and Petrulis K participated in the data acquisition and analysis; Norkus D, Burneckis A and Valuckas KP supervised the project and made critical revisions.
Correspondence to: Dr. Audrius Dulskas, Center of Oncosurgery, Institute of Oncology, Vilnius University, 1 Santariskiu Street, LT-08406, Vilnius, Lithuania. audrius.dulskas@gmail.com
Telephone: +370-67-520094   Fax: +370-27-20164
Received: November 25, 2012
Revised: April 19, 2013
Accepted: May 7, 2013
Published online: August 14, 2013
Processing time: 260 Days and 15.5 Hours
Abstract

AIM: To evaluate the results of hemorrhagic radiation proctopathy treatment with a 4% formalin application.

METHODS: A prospective study was performed. Over a three-year period, 38 patients underwent 4% formalin application under perianal anesthetic infiltration for hemorrhagic radiation proctopathy. All patients included in the study were irradiated for prostate cancer. The patients ranged in age from 56-77 years (average 70 ± 5 years). All of the patients were referred for formalin therapy after noninvasive management had failed. Twenty-four (63.2%) patients underwent a single application, 10 (26.3%) patients underwent 2 applications, and 4 (10.5%) patients underwent 3 applications.

RESULTS: Two to 36 mo (average 12 ± 3 mo) following treatment, 34 patients were interviewed (four were lost to follow-up). Twenty (58.8%) subjects reported complete cure, 8 (23.5%) subjects reported significant improvement, and 6 (17.7%) subjects reported no change. One patient (who underwent a colostomy at a regional hospital with no specialized services available for previous bleeding episodes from radiation proctopathy) was cured, and the colostomy was closed. One patient (2.6%) developed rectal mucosal damage after the second application.

CONCLUSION: A 4-min application of 4% formalin for hemorrhagic radiation-induced proctopathy under perianal anesthetic infiltration in patients who have received external radial radiation therapy for prostate cancer is simple, reasonably safe, inexpensive, generally well tolerated, and effective.

Keywords: Formalin application; Radiation proctopathy; Rectal bleeding; Prostate cancer

Core tip: In a prospective study conducted from 2006 to 2009, 38 patients underwent 4% formalin application under perianal anesthetic infiltration for hemorrhagic radiation proctopathy. Based on the rectal-telangiectasia density classification, eight (21.1%) patients had grade I proctitis, 23 (60.5%) patients had grade II proctitis, and seven (18.4%) patients had grade III proctitis. A piece of gauze soaked with 4% formalin was applied to the entire diseased rectal mucosa and remained for 4 min under perianal anesthetic infiltration. Twenty patients (58.8%) reported complete cure, eight patients (23.5%) reported significant improvement, and six patients (17.7%) reported no change. Application of 4% formalin under perianal anesthetic infiltration in patients who received external radial radiation therapy for prostate cancer was simple, safe, and effective.