title: Is argon plasma coagulation an effective and safe treatment option for patients with chronic radiation proctitis after high doses of radiotherapy?
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  The aim of this study was to assess the efficacy and toxicity of APC in the management of bleeding radiationinduced proctitis in patients treated with high doses of radiation for prostate cancer.
  
  
  METHODS
  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.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Hortelano
authors.forename: Alfonso
authors.initials: A
authors.lastname: Gómez-Iturriaga
authors.forename: Roberto
authors.initials: R
authors.lastname: Ortiz-de-Zárate
authors.forename: Manuel
authors.initials: M
authors.lastname: Zaballa
authors.forename: Ángel
authors.initials: Á
authors.lastname: Barturen
authors.forename: Francisco
authors.initials: F
authors.lastname: Casquero
authors.forename: Íñigo
authors.initials: Í
authors.lastname: San-Miguel
authors.forename: Carvajal
authors.initials: C
authors.lastname: Carvajal
authors.forename: Jon
authors.initials: J
authors.lastname: Cacicedo
authors.forename: Olga
authors.initials: O
authors.lastname: Del-Hoyo
authors.forename: Javier
authors.initials: J
authors.lastname: Lupiani
authors.forename: Fernando
authors.initials: F
authors.lastname: Pérez
authors.forename: Pedro
authors.initials: P
authors.lastname: Bilbao
mesh_terms: D000368:Aged; D057908:Argon Plasma Coagulation / Q000379:methods*; D002908:Chronic Disease; D023381:Endpoint Determination; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000209:etiology* / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000150:complications / Q000532:radiotherapy; D011829:Radiation Dosage; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies