S640 Best Therapies for Chronic Radiation Proctitis: A 10-Year VA Experience

Introduction: Radiation therapy involving the gastrointestinal tract is frequently used for pelvic malignancies (prostate, bladder, uterus, and testes). Injury to the rectum can be acute or chronic. Chronic injury is due to progressive occlusive vasculopathy with fibrosis, sub-mucosal thickening and development of telangiectasias. These telangiectasias cause significant iron deficiency anemia and frequent lower intestinal bleeding requiring transfusions, iron supplement, intra-rectal formalin, topical steroids, mesalamine and targeted ablative therapies with argon plasma coagulation (APC) or radio-frequency ablation (RFA). This study compares APC, RFA and medical therapies. Methods: A retrospective review from January 2005 until December 2014 at VA Loma Linda Healthcare System (VALLHCS) of patients receiving radiation therapy for pelvic malignancies in subjects 18 and over and presenting with rectal bleeding, found via an ICD-9 search for chronic radiation proctitis. All patients underwent colonoscopy for diagnosis and conditions of inflammatory bowel disease (IBD), hemorrhoids, malignancies, ischemia, diverticular bleeding were excluded. Subjects receiving APC, RFA, RFA+APC and standard medical therapy were included. Results: Forty-eight patients were included in the study. Thirty-two received APC, 11 received both APC and RFA and 5 received only medical therapy. The endoscopic severity for each group was defined as mild, moderate, or severe. The RFA group had all severe cases, the APC group had 6% severe and rest mild or moderate. The medical group was 20% mild and 80% moderate (Table-1). Rates of bleeding, hospitalizations, transfusions, and improved quality of life did not show any significant differences; though the APC group had post treatment improvement in hemoglobulin (hg) levels, decreased bleeding, and fewer visits. This is likely due to less severe involvement. Conclusion: This ten-year experience makes, an attempt to outline a treatment strategy based upon the severity of the rectal involvement. RFA was used to treat large areas of involvement, and APC or medical therapy for lesser involvement. Each modality was successful in treating the patient depending on the area involved.Table 1.: Primary outcomes measures.