Combined Therapy in Radiation Proctopathy

Chronic radiation proctopathy (CRP) or proctosigmoiditis is a late complication of pelvic radiotherapy. Symptoms, including diarrhea, rectal bleeding, urgency, and tenesmus, are difficult to treat and adversely impact patient quality of life. Various treatments directed at the reduction of blood loss and improvement of other symptoms have been evaluated, with the most encouraging results reported for two methods: endoscopic argon plasma coagulation (APC) of radiation-induced abnormal vessels in the rectal mucosa, and administration of sucralfate, a drug believed to enhance the mucosal defense and healing when administered orally or rectally. Adequately powered randomized trials comparing various treatments are lacking, and an optimal management strategy has yet to be determined. To address this issue, we conducted a single-center, randomized, placebo-controlled, double-blind study comparing the efficacy and safety of APC alone and APC in combination with sucralfate administered orally.

Inclusion criteria

• radiotherapy due to pelvic tumors completed at least three months prior to enrollment
• presence of rectal bleeding
• radiation-induced telangiectasia in the rectum and/or sigmoid colon on endoscopy
• informed written consent to participate in the study

Exclusion criteria

• history of clinically significant rectal bleeding prior to radiotherapy
• conditions predisposing the patient to rectal bleeding including inflammatory bowel disease, tumors of the large bowel, intestinal vascular lesions (other than radiation-induced telangiectasia), and diversion of the fecal stream
• sucralfate treatment during the two weeks prior to enrollment
• renal insufficiency (creatinine level ≥2 mg/dl)
• concurrent chemotherapy
• concurrent therapy with tetracycline, fluoroquinolones, or antimycotic drugs (because of drug interaction)
• concurrent therapy with oral anticoagulants