ENDOSCOPIC VS COMBINED MEDICAL AND SURGICAL MODALITIES OF TREATMENT OF RADIATION INDUCED PROCTOCOLITIS – OUR INSTITUTE EXPERIENCE

Background: GIGastrointestinal injury may occur following irradiation of thoracic,abdominal,and pelvic malignancieslimiting radiation doses that can be delivered as well as causing significant morbidity requiring intervention. Radiationproctocolitis, both acute and chronic, is one such complication requiring multidisciplinary management for goodoutcomes.We analyzed the injury with respect to spectrum of injury, severity, morbidity and compared endoscopic vscombined medical and surgical modalities of treatment.Methods: Patients with acute and chronic radiation proctocolitis defined as illness presenting before and after 3 monthsrespectively,of radiation treatment were included in the study.The study period was five years.Results: Total number of patients studied were 75.Acute disease was seen in 5 patients,presenting predominantly withdiarrhea, abdominal pain and acute intestinal pseudo-obstruction. Chronic radiation proctocolitis was seen in 70patients. Bleeding per rectum was the most common symptom. Anemia was the commonest sign. Grade 2 injury wasmost commonly seen. Pharmacotherapy was equally effective in grade 1 injury whereas Endoscopic treatment wassuperior to pharmacotherapy in Grade 2,3. Surgery offered lesser rates of rehospitalization in grade 3 but wasassociated with higher complications. There were no deaths in endoscopic arm while there were 2 deaths in pts whorequired surgery. Surgical combined with medical was superior to endoscopic treatment in grade 4 while local agentswere ineffective.Preventive strategies prior to radiation were associated with lower grade of injury.Conclusion: Radiation proctocolitis causes significant morbidity requiring prolonged treatment and hospitalization.Dose and duration of radiation had direct relation to the severity of injury. Concurrent chemotherapy had no effect onseverity of injury.Our study showed acute proctocolitis required predominantly supportive medical treatment.Chronicform from grade 1 to 3 required predominantly endoscopic treatment with prolonged duration of treatment but lessmorbidity.Grade 4 required surgical and intensive care and local therapy was ineffective.