title: Long-term control of refractory hemorrhagic radiation proctitis with ozone therapy.
abstract: BACKGROUND
  Persistent or severe hemorrhagic radiation proctitis (HRP) has limited therapeutic options.
  
  
  OBJECTIVE
  To describe our experience with ozone therapy (O3T) in the management of refractory HRP.
  
  
  METHODS
  Patients (n=17; median age 69 years [range 42-80 years]) previously irradiated for prostate or uterine cancer and suffering persistent or severe HRP without response to conventional treatment were enrolled to receive an O3/O2 gas mixture via rectal insufflations and topical application of ozonized oil. Most of the patients (83%) had Grade 3 or Grade 4 toxicity. Median follow-up post-O3T was 40 months (range 3-56 months).
  
  
  RESULTS
  Endoscopic treatments required were: 43 (median 1; range 0-10) pre-O3T; 17 (median 0; range 0-8; P=0.063) during O3T; and five (median 0; range 0-2; P=0.008) during follow-up. Hemoglobin levels were 10.35g/dL (7-14g/dL) pre-O3T and 13g/dL (9-15g/dL) (P=0.001) post-O3T. Median toxicity grades were 3 (range 2-4) pre-O3T, 1 (range 0-2; P<0.001) at the end of O3T, and 0 (range 0-1; P<0.001) at the last follow-up.
  
  
  CONCLUSIONS
  Persistent advanced HRP was significantly improved with O3T. The addition of O3T can be useful as a complementary treatment in the long-term management of HRP and, as such, merits further evaluation.
authors.affiliation: Radiation Oncology Department, Dr. Negrin University Hospital, Las Palmas, Spain. bernardinoclavo@gmail.com
authors.forename: Bernardino
authors.initials: B
authors.lastname: Clavo
authors.forename: Daniel
authors.initials: D
authors.lastname: Ceballos
authors.forename: Dominga
authors.initials: D
authors.lastname: Gutierrez
authors.forename: Gloria
authors.initials: G
authors.lastname: Rovira
authors.forename: Gerardo
authors.initials: G
authors.lastname: Suarez
authors.forename: Laura
authors.initials: L
authors.lastname: Lopez
authors.forename: Beatriz
authors.initials: B
authors.lastname: Pinar
authors.forename: Auxiliadora
authors.initials: A
authors.lastname: Cabezon
authors.forename: Victoria
authors.initials: V
authors.lastname: Morales
authors.forename: Elena
authors.initials: E
authors.lastname: Oliva
authors.forename: Dolores
authors.initials: D
authors.lastname: Fiuza
authors.forename: Norberto
authors.initials: N
authors.lastname: Santana-Rodriguez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010126:Ozone / Q000627:therapeutic use*; D011349:Proctitis / Q000209:etiology / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011832:Radiation Injuries / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000532:radiotherapy
chemical_list: D010126:Ozone
keywords: Gynecologic tumors; integrative and complementary medicine; pelvic radiotherapy; prostate cancer; rectal bleeding; side effects; toxicity