Argon plasma coagulation has a long-lasting therapeutic effect in patients with chronic radiation proctitis

Karamanolis, George; Triantafyllou, Konstantinos; Tsiamoulos, Zacharias P.; Polymeros, Dimitrios; Kalli, Theodora; Misailidis, Nikos; Ladas, Spyridon

doi:10.1055/s-0029-1214726

Cited by 72 publications

(70 citation statements)

References 11 publications

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“…Indeed, evidence comes from several retrospective and prospective case-series and observational studies, while only a few, small-sized RCTs comparing APC to formalin application have been conducted [49][50][51][52][53][54][55][56][57][58] . A systematic review focusing on studies published upon 2011 found that APC improved or completely resolved symptoms in 50% to 100% of patients [59] .…”

Section: Evidencesmentioning

confidence: 99%

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Pelvic radiation disease: Updates on treatment options

Frazzoni

Marca

Guido

et al. 2015

WJCO

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Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiationtreated patients say that their quality of life is affected by GI symptoms (e.g. , rectal bleeding, diarrhoea). The constellation of GI symptoms -from transient to longterm, from mild to very severe -experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e. , medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e. , causing chronic anemia) should firstly be considered for medical management (i.e. , sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments.

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Section: Evidencesmentioning

confidence: 99%

“…Severe complications have been rarely described, including gas explosion and perforation, fistula, stricture, and long-term pain [51,58,62] . Notably, colonic explosion mostly occurred when the endoscopic procedure was performed after inaccurate, local bowel cleansing with enemas, instead of gold-standard oral preparation [53,57] .…”

Section: Evidencesmentioning

confidence: 99%

Pelvic radiation disease: Updates on treatment options

Frazzoni

Marca

Guido

et al. 2015

WJCO

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“…It can occur from 9 months to 30 years after index treatment, although most patients present within 1 to 2 years of treatment. [71][72][73][74] Rectal bleeding is the leading sign of radiation proctopathy. The bleeding is rarely life threatening.…”

Section: Anal Fissurementioning

confidence: 99%

“…84 APC results in a decrease in rectal bleeding in 80% to 90% of patients and also may improve symptoms such as urgency and diarrhea. 85,86 In most cases, 1 to 3 treatment sessions are required. Power settings of 25 W to 60 W and flow rates of 0.5 L/minute to 2.5 L/minute have been reported.…”

Section: Anal Fissurementioning

confidence: 99%

Anorectal bleeding: etiology, evaluation, and management (with videos)

Daram

Lahr

Tang

2012

Gastrointestinal Endoscopy

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“…Villavicencio et al demonstrated the successful short-term resolution of rectal bleeding after APC treatment in >90% of patients who previously did not respond to medical or other endoscopic therapies [98]. In other studies, success rates are between 83% and 100% after one to four APC sessions [99][100][101][102][103]. Complications of APC are low, and reported cases of rectal ulceration leading to fi stula development range from <1% to 2%.…”

Section: Treatment and Preventionmentioning

confidence: 99%

Gastrointestinal toxicity associated to radiation therapy

et al. 2010

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Radiation therapy in combination with other treatments, such as surgery and chemotherapy, increases locoregional control and survival in patients with thoracic, abdominal and pelvic malignancies. Nevertheless, significant clinical toxicity with combined treatments may be seen in these patients. With the advent of tridimensional conformal radiotherapy (3D-CRT), dose-volume histograms (DVH) can be generated to assess the dose received by the organs at risk. The possible relationship between these parameters and clinical, anatomical and, more recently, genetic factors has to be considered. Treatment options include initial conservative medical therapies, endoscopic procedures, hyperbaric oxygen and surgery. Some pharmacological agents to prevent gastrointestinal toxicity are under investigation.

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Argon plasma coagulation has a long-lasting therapeutic effect in patients with chronic radiation proctitis

Abstract: APC is highly effective in all patients with mild radiation proctitis and in the majority of those with severe disease, providing long-lasting clinical remission.

Cited by 72 publications

References 11 publications

Pelvic radiation disease: Updates on treatment options

Pelvic radiation disease: Updates on treatment options

Anorectal bleeding: etiology, evaluation, and management (with videos)

Gastrointestinal toxicity associated to radiation therapy

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