Is argon plasma coagulation an effective and safe treatment option for patients with chronic radiation proctitis after high doses of radiotherapy?
Introduction: In severe cases refractory to medical treatment, APC appears to be the preferred alternative to control persistent rectal bleeding of patients with chronic radiation proctitis. Although successful outcomes have been demonstrated in patients previously treated with moderate doses of rad...
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doaj-8b8fa29ecb284fc087f28cba38990f132020-11-25T02:51:09ZengAran EdicionesRevista Espanola de Enfermedades Digestivas1130-01081063165170S1130-01082014000300003Is argon plasma coagulation an effective and safe treatment option for patients with chronic radiation proctitis after high doses of radiotherapy?Eduardo Hortelano0Alfonso Gómez-Iturriaga1Roberto Ortiz-de-Zárate2Manuel Zaballa3Ángel Barturen4Francisco Casquero5Íñigo San-Miguel6Claudia Carvajal7Jon Cacicedo8Olga del Hoyo9Javier Lupiani10Fernando Pérez11Pedro Bilbao12Hospital Universitario de CrucesHospital Universitario de CrucesHospital Universitario de CrucesHospital Universitario de CrucesHospital Universitario de CrucesHospital Universitario de CrucesHospital Universitario de CrucesHospital Universitario de CrucesHospital Universitario de CrucesHospital Universitario de CrucesHospital Universitario de CrucesHospital Universitario de CrucesHospital Universitario de CrucesIntroduction: In severe cases refractory to medical treatment, APC appears to be the preferred alternative to control persistent rectal bleeding of patients with chronic radiation proctitis. Although successful outcomes have been demonstrated in patients previously treated with moderate doses of radiotherapy, there is reluctance towards its indication due to the concern of severe adverse events in patients treated with high doses of radiation. Objectives: The aim of this study was to assess the efficacy and toxicity of APC in the management of bleeding radiation-induced proctitis in patients treated with high doses of radiation for prostate cancer. Methods and materials: Data from 30 patients were treated with APC due to chronic radiation proctitis, were reviewed retrospectively. All cases had prostate cancer and 9 of them (30 %) underwent previous radical prostatectomy. The median dose of conformal 3D External Beam Radiotherapy (EBRT) delivered was 74 Gy (range 46-76). Median rectal D1cc and D2cc was 72.5 and 72.4 Gy respectively. Median rectal V70, V60 and V40 was 12, 39.5 and 80 %. Cardiovascular and digestive disease, diabetes, smoking behaviour, lowest haemoglobin and transfusion requirements were recorded. Indications for treatment with APC were anemia and persistent bleeding despite medical treatment. Argon gas flow was set at 1.8 l/min with an electrical power setting of 50 W. Results: Median age of all patients was 69.6 years. The median lowest haemoglobin level was 9.6 g/dL. Median time between completion of radiotherapy and first session of APC was 13 months. Ninety-four therapeutic sessions were performed (median 3 sessions). Median time follow-up was 14.5 months (range 2-61). Complete response with resolved rectal bleeding was achieved in 23 patients (77 %), partial response in 5 (16 %) and no control in 2 (6 %). No patients required transfusion following therapy. Two patients developed long-term (> 6 weeks) grade 2 rectal ulceration and grade 2 rectal incontinence, respectively. Conclusions: The argon plasma coagulation is an effective and safe management option in patients with medically refractory rectal bleeding after high doses of radiation for prostate cancer.http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082014000300003&lng=en&tlng=enargon plasma coagulationradiation proctitisprostate cancerexternal beam radiation therapy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Eduardo Hortelano Alfonso Gómez-Iturriaga Roberto Ortiz-de-Zárate Manuel Zaballa Ángel Barturen Francisco Casquero Íñigo San-Miguel Claudia Carvajal Jon Cacicedo Olga del Hoyo Javier Lupiani Fernando Pérez Pedro Bilbao |
spellingShingle |
Eduardo Hortelano Alfonso Gómez-Iturriaga Roberto Ortiz-de-Zárate Manuel Zaballa Ángel Barturen Francisco Casquero Íñigo San-Miguel Claudia Carvajal Jon Cacicedo Olga del Hoyo Javier Lupiani Fernando Pérez Pedro Bilbao Is argon plasma coagulation an effective and safe treatment option for patients with chronic radiation proctitis after high doses of radiotherapy? Revista Espanola de Enfermedades Digestivas argon plasma coagulation radiation proctitis prostate cancer external beam radiation therapy |
author_facet |
Eduardo Hortelano Alfonso Gómez-Iturriaga Roberto Ortiz-de-Zárate Manuel Zaballa Ángel Barturen Francisco Casquero Íñigo San-Miguel Claudia Carvajal Jon Cacicedo Olga del Hoyo Javier Lupiani Fernando Pérez Pedro Bilbao |
author_sort |
Eduardo Hortelano |
title |
Is argon plasma coagulation an effective and safe treatment option for patients with chronic radiation proctitis after high doses of radiotherapy? |
title_short |
Is argon plasma coagulation an effective and safe treatment option for patients with chronic radiation proctitis after high doses of radiotherapy? |
title_full |
Is argon plasma coagulation an effective and safe treatment option for patients with chronic radiation proctitis after high doses of radiotherapy? |
title_fullStr |
Is argon plasma coagulation an effective and safe treatment option for patients with chronic radiation proctitis after high doses of radiotherapy? |
title_full_unstemmed |
Is argon plasma coagulation an effective and safe treatment option for patients with chronic radiation proctitis after high doses of radiotherapy? |
title_sort |
is argon plasma coagulation an effective and safe treatment option for patients with chronic radiation proctitis after high doses of radiotherapy? |
publisher |
Aran Ediciones |
series |
Revista Espanola de Enfermedades Digestivas |
issn |
1130-0108 |
description |
Introduction: In severe cases refractory to medical treatment, APC appears to be the preferred alternative to control persistent rectal bleeding of patients with chronic radiation proctitis. Although successful outcomes have been demonstrated in patients previously treated with moderate doses of radiotherapy, there is reluctance towards its indication due to the concern of severe adverse events in patients treated with high doses of radiation. Objectives: The aim of this study was to assess the efficacy and toxicity of APC in the management of bleeding radiation-induced proctitis in patients treated with high doses of radiation for prostate cancer. Methods and materials: Data from 30 patients were treated with APC due to chronic radiation proctitis, were reviewed retrospectively. All cases had prostate cancer and 9 of them (30 %) underwent previous radical prostatectomy. The median dose of conformal 3D External Beam Radiotherapy (EBRT) delivered was 74 Gy (range 46-76). Median rectal D1cc and D2cc was 72.5 and 72.4 Gy respectively. Median rectal V70, V60 and V40 was 12, 39.5 and 80 %. Cardiovascular and digestive disease, diabetes, smoking behaviour, lowest haemoglobin and transfusion requirements were recorded. Indications for treatment with APC were anemia and persistent bleeding despite medical treatment. Argon gas flow was set at 1.8 l/min with an electrical power setting of 50 W. Results: Median age of all patients was 69.6 years. The median lowest haemoglobin level was 9.6 g/dL. Median time between completion of radiotherapy and first session of APC was 13 months. Ninety-four therapeutic sessions were performed (median 3 sessions). Median time follow-up was 14.5 months (range 2-61). Complete response with resolved rectal bleeding was achieved in 23 patients (77 %), partial response in 5 (16 %) and no control in 2 (6 %). No patients required transfusion following therapy. Two patients developed long-term (> 6 weeks) grade 2 rectal ulceration and grade 2 rectal incontinence, respectively. Conclusions: The argon plasma coagulation is an effective and safe management option in patients with medically refractory rectal bleeding after high doses of radiation for prostate cancer. |
topic |
argon plasma coagulation radiation proctitis prostate cancer external beam radiation therapy |
url |
http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082014000300003&lng=en&tlng=en |
work_keys_str_mv |
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