Treatment of Radiation Proctitis with Argon Plasma Coagulation

Tam, William; Moore, James W.; Schoeman, Mark

doi:10.1055/s-2000-9020

Cited by 95 publications

(67 citation statements)

References 19 publications

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“…Patients refractory to endoscopic treatment or with grade-4 rectal toxicity (fewer than 10%) may be surgically treated. Regarding treatment with argon plasma, reported responses vary between 83 to 100% of patients treated after 2-3 sessions, with very few complications (15)(16)(17). In our study we found no treatment-derived complication, and the percentage of patients that needed 3 or fewer sessions for symptom relief and endoscopic improvement was 68%.…”

Section: Discussionsupporting

confidence: 51%

Effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis

Tormo

Wikman-Jorgensen

Castillo

et al. 2009

Rev. esp. enferm. dig.

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Introduction: there are two kinds of actinic proctitis -one is acute and self-limited, and lasts about 3 months; the other is chronic and develops months to years after radiation therapy. The incidence of chronic actinic proctitis is about 5-20% of radiated prostate tumors.Objective: to evaluate the effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis.Material and method: a retrospective search of patients with the diagnosis of actinic proctitis. The number of argon plasma coagulation therapies needed to achieve the symptom resolution was analyzed.Results: we found 22 patients with a diagnosis of actinic proctitis. Nineteen were males (86.7%) and three (13.6%) were females. Nineteen patients (86.4%) had a diagnosis of prostate adenocarcinoma, one had a diagnosis of squamous-cell cervix carcinoma (4.5%), and two had a diagnosis of endometrial carcinoma (9.1%). The mean number of coagulation sessions needed for symptom resolution was 2.58 (absolute range 1-7) with a median of 2 sessions.Conclusion: multiple treatments are described in the literature. None of them have shown promising results. Our results suggest that argon plasma coagulation is effective in the treatment of this condition, and achieves a rapid and sustained response with few sessions and a good safety profile.

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Section: Discussionsupporting

confidence: 51%

Effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis

Tormo

Wikman-Jorgensen

Castillo

et al. 2009

Rev. esp. enferm. dig.

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“…86 In several other studies, cessation of bleeding was reported after 1 to 3 sessions of APC. [87][88][89][90][91][92] Complications of APC include rectal pain, rectal stenosis, altered bowel habits, and rectal wall injury. Reported rates of rectal ulceration leading to fistula development range from <1% to 2%.…”

Section: Argon Plasma Coagulationmentioning

confidence: 99%

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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“…El argón plasma es un método eficaz y relativamente seguro para el control de la rectorragia y/o anemia que se produce en la rectitis actínica crónica, tal y como han mostrado las diversas series publicadas (22)(23)(24)(25), aunque con menor número de pacientes. Todos coinciden en la mejoría sintomática de la rectorragia, oscilando entre el 80 y el 99% (23)(24)(25)(26).…”

Section: Discussionunclassified

“…El argón plasma es el sistema más utilizado en los últi-mos años por su bajo número de complicaciones (20)(21)(22)(23) y por su relativo bajo coste. Es utilizado como sistema de electrocoagulación en las lesiones vasculares.…”

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Valoración de la respuesta endoscópica al tratamiento con argón plasma en la rectitis actínica crónica

Sánchez

García-Argüelles

Cerdá³

et al. 2008

Rev. esp. enferm. dig.

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INTRODUCCIÓNLa rectitis actínica crónica es una enfermedad con una incidencia que oscila del 2 al 20% (1) en los pacientes que han recibido radioterapia como tratamiento de tumoValoración de la respuesta endoscópica al tratamiento con argón plasma en la rectitis actínica crónica Vol. 100. N.°10, pp. 619-624, 2008 Recibido: 03-06-08. Aceptado: 17-06-08. RESUMENObjetivo: valorar la mejoría endoscópica tras el tratamiento con argón plasma utilizado para el control sintomático de las rectitis actínicas crónicas.Diseño y pacientes: estudio prospectivo de 48 meses de duración, con 38 pacientes (26 hombres y 12 mujeres, con edad media de 70,9 ± 7,38 años). Todos presentaban algún grado de rectorragia y/o anemia. Se realizaron entrevistas clínicas, analíti-cas y sesiones endoscópicas con argón, de forma periódica mensual, hasta la normalización analítica y cese del sangrado, con un seguimiento posterior de 24 meses. Para valorar la mejoría se utilizaron parámetros analíticos, gradación de sangrado (Chutckan) y un índice endoscópico.Resultados: el tiempo medio trascurrido entre el inicio y la finalización del seguimiento fue de 28,5 ± 3,9 meses. La media de sesiones administradas por paciente ha sido de 3,6 ± 2,7. Si comparamos los síntomas antes, después del tratamiento existe una disminución significativa en el grado de rectorragia según la clasificación de Chutkan (2,29 ± 1,08 vs. 0,59 ± 1,12, p < 0,05). Cuando comparamos los valores medios de la hemoglobina, antes y después del tratamiento apreciamos una aumento estadísticamente significativo (11,33 ± 3,05 mg/dl vs. 14,014 ± 1,29 mg/dl, p < 0,001) así como los valores medios de ferritina (31,15 ± 66, 45 µg/dl vs. 80,60 ± 55,60 µg/dl, p < 0,05). En el índice endoscópico, también existe una mejoría evidente de la afectación endoscópica tras el tratamiento con respecto a la friabilidad (p < 0,0001) y porcentaje de mucosa afecta (p < 0,0001).Conclusión: el argón plasma es eficaz y la realización del índi-ce endoscópico es una herramienta útil para valorar la mejoría endoscópica de las lesiones tras el tratamiento.Palabras clave: APC. Argón plasma coagulación. Rectitis actíni-ca crónica. Rectorragia. Anemia. ABSTRACTObjectives: to evaluate endoscopic improvement after argon plasma coagulation (APC) in symptomatic patients with chronic radiation proctopathy.Methods and patients: a prospective study of 38 patients with radiation proctitis (26 males and 12 females, mean age 70.9 ± 7.38 yrs), and with rectal bleeding and or anemia. We performed monthly interviews, blood tests, and APC sessions until rectal bleeding had ceased and hemoglobin and ferritin levels were improved, with a follow-up of 24 months. We used blood testing, bleeding scores (Chutckhan's index), and endoscopic scores to evaluate improvement.Results: mean time between inclusion and follow-up completion was 28.5 ± 3.9 months. Mean number of sessions per patient was 3.6 ± 2.7. There was a significant decrease (2.29 ± 1.8 vs. 0.59 ± 1.12, p < 0.05) in rectal bleeding (Chutckan score) from baseline after AP...

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Treatment of Radiation Proctitis with Argon Plasma Coagulation

Abstract: APC improved patient well-being and significantly reduced rectal bleeding in patients with radiation proctitis. Transfusion requirements were also reduced. APC is useful and safe in patients in whom radiation proctitis is refractory to other treatments.

Cited by 95 publications

References 19 publications

Effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis

Effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis

Late rectal complications after prostate brachytherapy for localized prostate cancer

Valoración de la respuesta endoscópica al tratamiento con argón plasma en la rectitis actínica crónica

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