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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2016; 8(7): 483-491
Published online Jul 27, 2016. doi: 10.4240/wjgs.v8.i7.483
Chronic haemorrhagic radiation proctitis: A review
Vishnu Prasad Nelamangala Ramakrishnaiah, Srinivasan Krishnamachari
Vishnu Prasad Nelamangala Ramakrishnaiah, Srinivasan Krishnamachari, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
Author contributions: Nelamangala Ramakrishnaiah VP and Krishnamachari S equally contributed to the minireview in designing and writing the aims, writing the methods, searching the literature and in writing the discussion and conclusions.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vishnu Prasad Nelamangala Ramakrishnaiah, MS, DNB, MNAMS, FMAS, MCh (GI Surgery), Professor of Surgery, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry 605006, India. vprasad285@gmail.com
Telephone: +91-413-2277586
Received: June 28, 2015
Peer-review started: July 5, 2015
First decision: August 9, 2015
Revised: April 29, 2016
Accepted: May 10, 2016
Article in press: May 11, 2016
Published online: July 27, 2016
Processing time: 378 Days and 23.1 Hours
Abstract

Chronic haemorrhagic radiation proctitis (CHRP) is a difficult problem faced by the patients following radiation for pelvic malignancy. There is no standard treatment for this condition, but many methods of treatment are available. The aim of this study was to review the literature to see whether there is an improvement in the available evidence in comparison with previously published systematic reviews in treating patients with CHRP. The PubMed/Medline database and Google Scholar search was selectively searched. Studies, which treated patients with rectal bleeding due to chronic radiation proctitis or CHRP, were included. Seventy studies were finally selected out of which 14 were randomized controlled clinical trials. Though these studies could not be compared, it could be seen that there was an improvement in the methodology of the studies. There was an objective assessment of symptoms, signs and an objective assessment of outcomes. But, still, there were only a few studies that looked into the quality of life following treatment of CHRP. To increase recruitment to trials, a national registry of cases with established late radiation toxicity would facilitate the further improvement of such studies. Some of the conclusions that could be reached based on the available evidence are 4% formalin should be the first line treatment for patients with CHRP. Formalin and argon plasma coagulation (APC) are equally effective, but formalin is better for severe disease. Refractory patients, not responding to formalin or APC, need to be referred for hyperbaric oxygen therapy or surgery. Radio-frequency ablation is a promising modality that needs to be studied further in randomized trials.

Keywords: Radiotherapy; Complications; Systematic review; Proctitis; Formalin

Core tip: The aim of this study was to review the literature to see whether there is an improvement in the available evidence in comparison with the previously published systematic reviews in treating patients with chronic haemorrhagic radiation proctitis (CHRP). The PubMed/Medline database and Google Scholar search was selectively searched. Seventy studies were finally selected out of which 14 were randomized controlled clinical trials. It could be seen that there was an improvement of the methodology of the studies though they were not comparable. Based on the available evidence, 4% formalin should be the first line treatment for patients with CHRP.