Conservative therapies for hemorrhagic radiation proctitis: a review

Cotti, Guilherme Cutait de Castro; Seid, Víctor Edmond; Araújo, Sérgio Eduardo Alonso; Souza, A H; Kiss, Desidério Roberto; Habr‐Gama, Angelita

doi:10.1590/s0041-87812003000500008

Cited by 41 publications

(47 citation statements)

References 51 publications

(35 reference statements)

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“…The majority of articles published on medical therapies for postradiation rectal bleeding are case reports or case series; only a few randomized trials have been performed. 7,11 In addition, the methods used to grade initial symptom severity or responses to therapy are not consistent. Because of these limitations, the management of rectal bleeding largely remains empirical.…”

Section: Management Of Rectal Bleeding Caused By Chronic Radiation Prmentioning

confidence: 99%

“…7 Sucralfate is administered orally and by suspension enema. Studies by Sasai et al demonstrated clinical and endoscopic improvement in 3 patients who received oral sucralfate.…”

Section: Sucralfatementioning

confidence: 99%

“…The incidence of chronic radiation proctitis has increased over the past few years along with increased use of radiation therapy for the treatment of prostate cancer. 7 The most common manifestation of radiation-induced rectal injury is rectal bleeding. Nonconservative management of rectal bleeding-for example, with argon plasma coagulation (APC) or rectal biopsy-may result in fistula development and the need for a colostomy.…”

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confidence: 99%

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Late rectal complications after prostate brachytherapy for localized prostate cancer

Phan¹,

Swanson²,

Levy³

et al. 2009

Cancer

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This review of the literature on late rectal complications after prostate brachytherapy indicated that it is a highly effective treatment modality for patients with clinically localized prostate cancer but can cause chronic radiation proctitis. The most common manifestation of chronic radiation proctitis was anterior rectal wall bleeding, which often occurred within the first 2 years after brachytherapy. It is interesting to note that the rates of late rectal morbidity appear to have declined over time, which may reflect improvements in implantation techniques and imaging. Rectal biopsy as part of the workup to evaluate rectal bleeding can lead to rectal fistula and the need for colostomy, a rare but major complication. The authors recommend 1) screening colonoscopy before brachytherapy for patients who have not had a screening colonoscopy within the preceding 3 years to rule out colorectal malignancies and, thus, facilitate conservative management should rectal bleeding occur; 2) lifestyle modifications during treatment to limit exposure of the rectum to radiation; and 3) conservative management for rectal bleeding that occurs within 2 years after brachytherapy. Prostate cancer is the leading cause of cancer in men and accounts for approximately 33% of cancer deaths among men in the US.1,2 Management options for organ-confined, low-to intermediate-risk prostate cancer include watchful waiting, radical prostatectomy, external-beam radiation therapy, and prostate brachytherapy with permanent interstitial implants. Recent improvements in radioactive seed implantation techniques have established prostate brachytherapy as a highly effective treatment modality for localized prostate cancer, with long-term local and biochemical control similar to outcomes observed after radical prostatectomy and external-beam radiation therapy. 3,4 Because prostate cancer is diagnosed

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Section: Management Of Rectal Bleeding Caused By Chronic Radiation Prmentioning

confidence: 99%

“…7 Sucralfate is administered orally and by suspension enema. Studies by Sasai et al demonstrated clinical and endoscopic improvement in 3 patients who received oral sucralfate.…”

Section: Sucralfatementioning

confidence: 99%

mentioning

confidence: 99%

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Late rectal complications after prostate brachytherapy for localized prostate cancer

Phan¹,

Swanson²,

Levy³

et al. 2009

Cancer

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“…Acute radiation proctitis is defined as development of symptoms immediately after initiation of treatment or within 3 months of treatment completion . Up to 20% patients require treatment interruption (Cotti et al, 2003).…”

Section: Risk Factorsmentioning

confidence: 99%

Radiation Induced Cystitis and Proctitis - Prediction, Assessment and Management

Mallick¹,

Madan²,

Julka³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Cystitis and proctitis are defined as inflammation of bladder and rectum respectively. Haemorrhagic cystitis is the most severe clinical manifestation of radiation and chemical cystitis. Radiation proctitis and cystitis are major complications following radiotherapy. Prevention of radiation-induced haemorrhagic cystitis has been investigated using various oral agents with minimal benefit. Bladder irrigation remains the most frequently adopted modality followed by intra-vesical instillation of alum or formalin. In intractable cases, surgical intervention is required in the form of diversion ureterostomy or cystectomy. Proctitis is more common in even low dose ranges but is self-limiting and improves on treatment interruption. However, treatment of radiation proctitis is broadly non-invasive or invasive. Non-invasive treatment consists of non-steroid anti-inflammatory drugs (NSAIDs), anti-oxidants, sucralfate, short chain fatty acids and hyperbaric oxygen. Invasive treatment consists of ablative procedures like formalin application, endoscopic YAG laser coagulation or argon plasma coagulation and surgery as a last resort.

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“…Os números citados de incidência de proctite tornam-se, no entanto, significativos considerando que, nos USA, há há cerca de 200.000 novos casos de cân-cer de próstata por ano, 82% dos quais em homens acima dos 65 anos de idade 55,56 , com o agravante de que o problema é crônico e de resolução 57 .…”

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Radioterapia: lesões inflamatórias e funcionais de órgãos pélvicos

Santos

2006

Rev bras. colo-proctol.

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RESUMO:A radioterapia pélvica tem sido cada vez mais indicada, em doses crescentes,como coadjuvante no tratamento das neoplasias pélvicas, com resultados cada vez melhores, mas com efeitos colaterais significativos. O advento da radioterapia tridimensional conformal estabelece um método que permite a mais precisa seleção de direção e de intensidade de raios emitidos para alvos pontuais, objetivando quase que exclusivamente o tumor, com a conseqüente preservação dos tecidos vizinhos, portanto com maior efetividade e com o mínimo de efeitos colaterais crônicos e insolúveis. Essas são as possibilidades teóricas que precisam ser comprovadas na prática.Elas envolvem um campo de observação cujos resultados reais tem sido subestimados, principalmente quando referidos a efeitos adversos. Esses não se limitam exclusivamente às mucosites, mas, também, a aspectos funcionais envolvendo incapacidades que vão, quando se trata do reto, além do que sempre foi atribuído à suposta síndrome da ressecção anterior 58 , para abranger danos diretos da radiação sobre os complexos esfincterianos e os nervos dos plexos lombosacrais 21,22,59-63 . Por enquanto, seja para o câncer de reto, para o câncer ginecológico e para o câncer de próstata, somos conclamados a investir no modelo mais preventivo do que curativo, ainda que o preventivo signifique apenas a mais precoce ação, pois para essas doenças de altas incidências e mortalidades "prevenir" no sentido de ação mais precoce é, sem dúvida, bem melhor que remediar, principalmente quando se faz uso das terapias neo-adjuvantes que poderiam ser dispensadas, em casos selecionados, para não somar ao desconforto emocional do portador do câncer todas as impossibilidades das iatrogenias inerentes ao tratamento que objetiva a cura. Assim, precisamos encontrar os fatores preditivos que nos permitam escolher os pacientes com probabilidade de cura apenas com o tratamento cirúrgico, para que eles fiquem livres da radioterapia e, por outro lado, buscar o aperfeiçoamento da técnica de radiação para os casos cujas necessidades excedam a abrangência do tratamento cirúrgico, exclusivo.Descritores: Doenças pélvicas malignas, radioterapia pélvica, lesões inflamatórias actínicas, distúrbios funcionais,iatrogenias. A operação cirúrgica desde que feita por meio de técnica adequada é requisito fundamental no tratamento do câncer do reto, não só objetivando a cura como também para evitar a recidiva local que é um evento catastrófico no qual os sintomas são debilitantes e a cura quase que impossível.Nessa questão, a abordagem do câncer do reto insere aspectos anatômicos, cujos interesses cirúrgi-cos e clínicos ficaram bem definidos após a divulgação da técnica da excisão total do mesorreto (ETM) [1][2][3] Os resultados obtidos com essa técnica cirúrgica têm índices de confrontação melhores que os observados com os métodos cirúrgicos convencionais. Nessa situação, a recidiva local foi descrita variando de 20 a 40% 4 , diminuídos, posteriormente, para cerca de 10% quando o procedimento cirúrgico foi antecipadamente c...

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Conservative therapies for hemorrhagic radiation proctitis: a review

Cited by 41 publications

References 51 publications

Late rectal complications after prostate brachytherapy for localized prostate cancer

Late rectal complications after prostate brachytherapy for localized prostate cancer

Radiation Induced Cystitis and Proctitis - Prediction, Assessment and Management

Radioterapia: lesões inflamatórias e funcionais de órgãos pélvicos

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