Pelvic radiation disease: Updates on treatment options

Table 1 Medical strategies for treating pelvic radiation disease

Medical treatments	Acute PRD	Chronic PRD	Notes
Topical sucralfate	N	Y	Twice-daily enema with two 1 g sucralfate tablets mixed with 4.5 mL of water is effective for chronic rectal bleeding
Metronidazole	N	Y	3 × 400 mg/d of metronidazole for up to 12 wk is effective for chronic rectal bleeding and diarrhea
Probiotics	Y	N	3 sachets/d of Lactobacillus rhamnosus for at least 1 wk is effective for acute diarrhea
Mesalazine	N	N	No recent RCTs available; one prospective study showed that combined oral and topic mesalazine was effective for chronic rectal bleeding
Corticosteroids	N	N	RCTs have not shown a substantial improvement with steroids administration
Hyperbaric oxygen	N	Y	At least 30 sessions (up to 100) are effective for chronic rectal bleeding not responding to medical treatment

Y: Evidence supports treatment; N: Evidence does not support treatment; PRD: Pelvic radiation disease; RCT: Randomized controlled trial.

Table 2 Endoscopic approaches for treating pelvic radiation disease

Endoscopic approaches	Rectal bleeding	Notes
Argon plasma coagulation	Y	Treatment of choice when clinically significant rectal bleeding occurs
Formalin	Y	Alternative to APC, but more prone to complications and requires more skilled endoscopist
Radio frequency ablation	N	No RCT available; possibly effective but more expensive than other treatments
Cryoablation	N	No RCT available; risk of cecal perforation
Rectal band ligation	N	Anecdotic case report

Y: Evidence supports treatment; N: Evidence does not support treatment; RCT: Randomized controlled trial; APC: Argon plasma coagulation.