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radiation proctopathy

Inês Pita, Pedro Bastos, Mário Dinis-Ribeiro
Chronic radiation proctopathy is a frequent complication after both pelvic external radiation therapy and brachytherapy and most commonly presents as rectal bleeding. Deep rectal ulcers and fistulae are much rarer and more clinically challenging consequences. We present the case of a 72-year-old male with a history of prostate adenocarcinoma treated with brachytherapy, who was referred to our institution due to a deep painful rectal ulcer refractory to medical treatment. The ulcer presented shortly after a haemorrhoid elastic band ligation and progressed to rectourethral fistulisation despite both faecal and urinary diversion...
January 2018: GE Portuguese Journal of Gastroenterology
Lei Wang, Tenghui Ma, Jianping Wang
Chronic radiation proctopathy (CRP) is the delayed adverse effect after radiotherapy for pelvic malignancies. It is characterized as progressive fibrosis in pathology. The symptoms are usually unspecific which include rectal bleeding, perianal pain, tenesmus, stool frequencies and so on. The course of CRP can present from months to years after radiation. Severe complications can occur in the late stage and will greatly affect the quality of life. Currently, there is no standard guides for diagnosis and treatment of CRP...
January 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
L Wang, Q Y Qin, T H Ma
Radiation proctopathy represents the feared injury of rectum resulting from radiotherapy to pelvic malignancy. Interstitial fibrosis is the major histopathologic feature of chronic radiation proctopathy, whose symptoms may improve over time without any management. Treatment decisions should be based on the pattern and severity of symptoms and endoscopic findings. Non-surgical interventions are generally used to relieve major symptoms and prevent severe complications. Surgery is reserved for patients with refractory complications...
July 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
L F McCrone, P M Neary, J Larkin, P McCormick, B Mehigan
BACKGROUND: There is sparse evidence guiding the optimum surgical management of patients with radiation proctopathy (RP). The purpose of this review is to analyse all the literature on the surgical management of RP in order to guide physicians and surgeons as to when and what surgery should be employed for these patients. METHODS: A literature search of PubMed, EMBASE, MEDLINE, Ovid, and Cochrane Library using the MeSH terms "radiation proctopathy", "proctitis", "surgical management", and related terms as keywords was performed...
August 2017: International Journal of Colorectal Disease
Xiang Sheng Li, Hong Fang, Yunlong Song, Dechang Li, Yingjie Wang, Hongxian Zhu, Limin Meng, Ping Wang, Dong Wang, Hongxia Fan
OBJECTIVE: To determine whether diffusion-weighted imaging (DWI) can be used for quantitatively evaluating severity of acute radiation proctopathy after radiotherapy for cervical carcinoma. MATERIALS AND METHODS: One hundred and twenty-four patients with cervical carcinoma underwent MR examination including DWI before and after radiotherapy. Acute radiation proctopathy was classified into three groups (grade 0, grade I-II and grade III-IV) according to Toxicity Criteria of the Radiation Therapy Oncology Group (RTOG)...
February 2017: European Journal of Radiology
Masahiro Ohtani, Hiroyuki Suto, Takuto Nosaka, Yasushi Saito, Yoshihiko Ozaki, Ryoko Hayama, Tatsushi Naito, Kazuto Takahashi, Kazuya Ofuji, Hidetaka Matsuda, Katsushi Hiramatsu, Tomoyuki Nemoto, Hiroki Shioura, Hirohiko Kimura, Yoshitaka Aoki, Osamu Yokoyama, Yasunari Nakamoto
Background. Chronic radiation proctopathy (CRP) is late toxicity and associated with morbidity. Aim. To investigate the predictors of prognosis in patients with CRP after brachytherapy (BT). Methods. One hundred four patients with prostate cancer were treated with BT or BT followed by external-beam radiotherapy (BT + EBRT). We retrospectively investigated the 5-year incidence of rectal bleeding and endoscopic findings of CRP using the Vienna Rectoscopy Score (VRS). Twenty patients with VRS ≥ 1 were divided into the improved VRS group without treatment, unchanged VRS group, and treated group...
2016: Diagnostic and Therapeutic Endoscopy
Fleur T van de Wetering, Leen Verleye, H Jervoise N Andreyev, Jane Maher, Joan Vlayen, Bradley R Pieters, Geertjan van Tienhoven, Rob J P M Scholten
BACKGROUND: This is an update of a Cochrane review first published in 2002, and previously updated in 2007. Late radiation rectal problems (proctopathy) include bleeding, pain, faecal urgency, and incontinence and may develop after pelvic radiotherapy treatment for cancer. OBJECTIVES: To assess the effectiveness and safety of non-surgical interventions for managing late radiation proctopathy. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 11, 2015); MEDLINE (Ovid); EMBASE (Ovid); CANCERCD; Science Citation Index; and CINAHL from inception to November 2015...
April 25, 2016: Cochrane Database of Systematic Reviews
Luciano Lenz, Rachel Rohr, Frank Nakao, Ermelindo Libera, Angelo Ferrari
Chronic radiation proctopathy (CRP) is a troublesome complication of pelvic radiotherapy. The most common presentation is rectal bleeding. CRP symptoms interfere with daily activities and decrease quality of life. Rectal bleeding management in patients with CRP represents a conundrum for practitioners. Medical therapy is ineffective in general and surgical approach has a high morbid-mortality. Endoscopy has a role in the diagnosis, staging and treatment of this disease. Currently available endoscopic modalities are formalin, potassium titanyl phosphate laser, neodymium:yttrium-aluminum-garnet laser, argon laser, bipolar electrocoagulation (BiCAP), heater probe, band ligation, cryotherapy, radiofrequency ablation and argon plasma coagulation (APC)...
February 27, 2016: World Journal of Gastrointestinal Surgery
Aymeric Becq, Marine Camus, Gabriel Rahmi, Vincent de Parades, Philippe Marteau, Xavier Dray
INTRODUCTION: Radiofrequency ablation (RFA) is a well-validated treatment of dysplastic Barrett's esophagus. Other indications of endoscopic RFA are under evaluation. RESULTS: Four prospective studies (total 69 patients) have shown that RFA achieved complete remission of early esophageal squamous intra-epithelial neoplasia at a rate of 80%, but with a substantial risk of stricture. In the setting of gastric antral vascular ectasia, two prospective monocenter studies, and a retrospective multicenter study, (total 51 patients), suggest that RFA is efficacious in terms of reducing transfusion dependency...
August 2015: United European Gastroenterology Journal
M T W Teo, D Sebag-Montefiore, C F Donnellan
In the UK, about 90,000 cancer survivors will suffer from pelvic radiation disease (PRD) due to their curative treatment including radiotherapy. The National Cancer Survivorship Initiative aims to improve the understanding and management of PRD by the oncology community. This overview covers the prevention, investigation and treatment for late radiation-induced gastrointestinal symptoms in PRD. Multiple pharmacological and nutritional interventions have been studied, as prophylaxis for acute gastrointestinal toxicity (aiming to prevent late consequential effects), although predominantly only small randomised controlled trials have been conducted...
November 2015: Clinical Oncology: a Journal of the Royal College of Radiologists
Marc B Grodsky, Shafik M Sidani
Radiation therapy is a widely utilized treatment modality for pelvic malignancies, including prostate cancer, rectal cancer, and cervical cancer. Given its fixed position in the pelvis, the rectum is at a high risk for injury secondary to ionizing radiation. Despite advances made in radiation science, up to 75% of the patients will suffer from acute radiation proctitis and up to 20% may experience chronic symptoms. Symptoms can be variable and include diarrhea, bleeding, incontinence, and fistulization. A multitude of treatment options exist...
June 2015: Clinics in Colon and Rectal Surgery
Xian-rui Wu, Xiu-li Liu, Seymour Katz, Bo Shen
Chronic proctitis refers to persistent or relapsing inflammation of the rectum, which results from a wide range of etiologies with various pathogenic mechanisms. The patients may share similar clinical presentations. Ulcerative proctitis, chronic radiation proctitis or proctopathy, and diversion proctitis are the 3 most common forms of chronic proctitis. Although the diagnosis of these disease entities may be straightforward in the most instances based on the clinical history, endoscopic, and histologic features, differential diagnosis may sometimes become problematic, especially when their etiologies and the disease processes overlap...
March 2015: Inflammatory Bowel Diseases
Anish Patel, Rahul Pathak, Vrushak Deshpande, Sunil H Patel, Prasanna C Wickremesinghe, Deepak Vadada
Radiation proctopathy is a complication of pelvic radiotherapy, which occurs in patients treated for carcinoma of the prostate, rectum, urinary bladder, cervix, uterus, and testes. If it presents within 6 weeks to 9 months after therapy, it is called acute radiation proctitis/proctopathy (ARP), and if it occurs 9 months to a year after treatment, it is classified as chronic radiation proctitis/proctopathy (CRP). CRP occurs in 5%-20% of patients receiving pelvic radiation, depending on the radiation dose and the presence or absence of chemotherapy...
2014: Clinical and Experimental Gastroenterology
Guang-Hong Guo, Feng-Ye Yu, Xing-Jie Wang, Fei Lu
PURPOSE: Chronic hemorrhagic radiation proctopathy is not uncommon after radiotherapy for cervical carcinoma. The outcomes of several treatments have been variable. Many studies demonstrate that topical treatment with 4 % formalin is effective and safe. However, a nonrandomized control study showed a high response rate and good tolerance in chronic radiation proctopathy patients treated with 10 % formalin. The optimal concentration of formalin therefore remains unclear. METHODS: To compare the effectiveness and safety of 4 and 10 % formalin for the treatment of chronic hemorrhagic radiation proctopathy, a prospective trial was conducted at the Department of Gynecology of the Affiliated Hospital of Binzhou Medical College from January 2009 to December 2012...
February 2015: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Tarun Rustagi, F Scott Corbett, Hiroshi Mashimo
BACKGROUND: Chronic radiation proctopathy (CRP) is a common sequela occurring even many years after pelvic radiation. Current ablative therapies for bleeding ectatic vessels have the potential for deep tissue injury leading to ulcerations, perforation, and fistulas. Radiofrequency ablation (RFA) therapy avoids deep tissue injury and is a promising treatment for CRP. OBJECTIVE: To assess the long-term safety and efficacy of RFA for the treatment of CRP. DESIGN: Multicenter, retrospective analysis of a prospectively collected database...
February 2015: Gastrointestinal Endoscopy
Myo Min, Benjamin Chua, Yvonne Guttner, Ned Abraham, Noel J Aherne, Matthew Hoffmann, Michael J McKay, Thomas P Shakespeare
BACKGROUND: Pelvic radiation disease (PRD) also widely known as "radiation proctopathy" is a well recognised late side-effect following conventional prostate radiotherapy. However, endoscopic evaluation and/or specialist referral for new or persistent post-prostate radiotherapy bowel symptoms is not routine and serious diagnoses may potentially be missed. Here we report a policy of endoscopic evaluation of bowel symptoms persisting >90 days post radiotherapy for prostate cancer. METHODS AND MATERIALS: A consecutive series of 102 patients who had radical prostate intensity-modulated radiotherapy (IMRT)/image-guided radiotherapy (IGRT) and who had new or ongoing bowel symptoms or positive faecal occult blood tests (FOBT) on follow up visits more than three months after treatment, were referred for endoscopic examination...
February 2014: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Siva P Raman, Karen M Horton, Elliot K Fishman
OBJECTIVE: This article reviews several different causes of rectal bleeding and the role of MDCT in diagnosis. CONCLUSION: Although colonoscopy remains the first-line modality for the diagnosis of lower gastrointestinal tract bleeding, colonoscopy may not be possible for unstable patients, and moreover, even for patients who undergo colonoscopy, the examination may still fail to diagnose a cause for bleeding. MDCT with CT angiography and 3D mapping now offers a valuable option for diagnosis, not only for patients whose colonoscopy findings were negative, but also as a first-line screening modality for patients with active bleeding and hemodynamic instability...
September 2013: AJR. American Journal of Roentgenology
Narimantas Evaldas Samalavicius, Audrius Dulskas, Alfredas Kilius, Kestutis Petrulis, Darius Norkus, Arvydas Burneckis, Konstantinas Povilas Valuckas
AIM: To evaluate the results of hemorrhagic radiation proctopathy treatment with a 4% formalin application. METHODS: A prospective study was performed. Over a three-year period, 38 patients underwent 4% formalin application under perianal anesthetic infiltration for hemorrhagic radiation proctopathy. All patients included in the study were irradiated for prostate cancer. The patients ranged in age from 56-77 years (average 70 ± 5 years). All of the patients were referred for formalin therapy after noninvasive management had failed...
August 14, 2013: World Journal of Gastroenterology: WJG
Caroline C Henson, Susan E Davidson, Yeng Ang, Chris Babbs, John Crampton, Mark Kelly, Simon Lal, Jimmy K Limdi, Greg Whatley, Ric Swindell, Wendy Makin, John McLaughlin
PURPOSE: Fifty percent of patients develop chronic gastrointestinal (GI) symptoms following pelvic radiotherapy that adversely affect quality of life. Fewer than 20 % are referred to a gastroenterologist. We aimed to determine if structured gastroenterological evaluation is of benefit to this patient group. METHODS: Sixty patients with GI symptoms at ≥ 6 months after radical pelvic radiotherapy were identified prospectively from oncology clinics in this service evaluation...
August 2013: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
David S Wolf, Brian J Dunkin, Atilla Ertan
Recently, extensive data have been published about the safety and efficacy of endoscopic radiofrequency ablation (RFA) of Barrett's esophagus (BE) with early cancer and dysplasia as well as without dysplasia. RFA has been shown to be effective and safe. Circumferential RFA is delivered using the HALO(360+) Ablation System (Covidien, Inc., Mansfield, MA), which consists ofa high-power energy generator, a sizing balloon catheter, and a number of balloon-based ablation catheters with varying outer diameters. Focal RF energy is delivered using the HALO(90) or HALO(60) Ablation Systems (Covidien, Inc...
December 2012: Surgical Technology International
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