Oral vitamin A enhances the effectiveness of formalin 8% in treating chronic hemorrhagic radiation proctopathy.
OBJECTIVE
Chronic radiation proctopathy occurs in 5 to 20% of patients receiving radiation therapy, with rectal bleeding as its most common presentation. Although formalin treatment for rectal bleeding is promising, improvement is possible. Given the success of vitamin A in other radiation-induced treatments, we studied the efficacy of combining formalin with vitamin A in controlling bleeding symptoms of chronic radiation proctopathy.


METHODS
A retrospective review (1993-2007) was performed of patients presenting with features of chronic radiation proctopathy. Formalin 8% in a buffered solution was applied to the affected mucosa with use a tip applicator, and 10,000 units of vitamin A were given orally on a daily basis. Formalin treatments were repeated at three-week to four-week intervals until symptoms resolved.


RESULTS
A comparison was made between patients who received formalin alone (n = 30) and those who received formalin in combination with vitamin A (n = 34). The 64 patients had a mean age of 79 years (range, 54-90 years). The combination group required fewer treatments (mean, 1.9) and a shorter time (11 weeks) for resolution of symptoms compared with the formalin-alone group (mean, 5.2 and 31 weeks, respectively) (P < 0.001). The overall success rate in controlling bleeding was only 64% in the formalin-alone group when compared with 94% in the combination group.


CONCLUSIONS
When vitamin A was added to the regimen, a significant reduction was observed in the number of treatments and the time needed for resolution of symptoms, and there was an increased overall success rate. This combination represents a simple, effective, and well tolerated method of controlling hemorrhagic chronic radiation proctopathy.
Patel
Purnal
P
Department of Surgery, Providence Hospital and Medical Centers, Southfield, Michigan 48075, USA.
Subhas
Gokulakkrishna
G
Gupta
Aditya
A
Chang
Yeon-Jeen
YJ
Mittal
Vijay K
VK
McKendrick
Alasdair
A
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000532:radiotherapy; D015331:Cohort Studies; D019587:Dietary Supplements; D005557:Formaldehyde / Q000008:administration & dosage*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011832:Radiation Injuries / Q000209:etiology / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects; D012002:Rectal Diseases / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D016896:Treatment Outcome; D014801:Vitamin A / Q000008:administration & dosage*; D014815:Vitamins / Q000008:administration & dosage*
D012597:Sclerosing Solutions; D014815:Vitamins; D014801:Vitamin A; D005557:Formaldehyde