Premium
Argon plasma coagulation is an effective treatment for chronic radiation proctitis in gynaecological malignancy: an observational study
Author(s) -
Sultania S.,
Sarkar R.,
Das K.,
Dhali G. K.
Publication year - 2019
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.14541
Subject(s) - medicine , argon plasma coagulation , radiation proctitis , observational study , proctitis , malignancy , coagulation , radiation therapy , general surgery , surgery , endoscopy , disease , ulcerative colitis
Aim Chronic radiation proctitis (CRP) develops in 5–15% of patients after pelvic radiation therapy, with rectal bleeding being the main symptom. Reports suggest that argon plasma coagulation (APC) can be an effective therapy for CRP following radiotherapy for prostate cancer, but there is less information about how useful it is after radiotherapy for gynaecological malignancy. The aim of this work therefore was to study the efficacy of APC for CRP after radiotherapy for gynaecological malignancy. Method This was a prospective study of consecutive patients with CRP following radiotherapy for gynaecological malignancy at IPGME&R, SDLD, Kolkata, India; symptoms included rectal bleeding grade (RBG) ≥ 2. APC was performed at monthly intervals to a maximum of four treatment sessions. Severity of disease at baseline was graded (endoscopically) by the total colonoscopic severity score (TCSS) and treatment response was assessed by reduction in RBG from ≥ 2 to ≤ 1 measured at > 6 months after cessation of APC. Results Seventy patients [90% with cervical cancer, 10% with endometrial cancer; mean age 51.93 ± 9.15 years; median RBG 3 (range 2–4)] received APC. Seven patients died due to underlying malignancy and seven patients were lost to follow‐up. Fifty‐six (85.7%) patients responded to therapy after a median of 2 (range 1–4) treatment sessions. Multivariate analysis demonstrated that a lower haemoglobin at the start of treatment predicted failure of therapy ( P < 0.05). Conclusion APC is an effective management option for CRP in female patients with gynaecological malignancy. However, the more anaemic the patient the less likely it is to be successful.