Long-term results on the efficacy of argon plasma coagulation for patients with chronic radiation proctitis after conventionally fractionated, dose-escalated radiation therapy for prostate cancer.
OBJECTIVE
This study was designed to assess the efficacy and outcomes of argon plasma coagulation (APC) in the management of chronic radiation proctitis after conventionally fractionated, dose-escalated radiation therapy (≥7560 cGy).


METHODS
We retrospectively reviewed the charts on all patients treated with external beam radiation therapy (minimum dose, 7560 cGy) for histologically confirmed prostate cancer at our institution from 2003 to 2011. Five hundred patients met these criteria; of these, 35 patients (7.0%) developed radiation proctitis necessitating intervention with APC. Indications for APC treatment were either the need for blood transfusions resulting from proctitis-related anemia or refractory bleeding despite medical management.


RESULTS
The median follow-up from the completion of radiation treatment was 78 months (range, 19-129) and the median follow up from the most recent APC treatment was 56 months (range, 3-112). Fifteen men (42.9%) needed blood transfusions because of proctitis-related anemia. For 19 patients (54.3%), bleeding was controlled after 1 or 2 treatments. Eventual bleeding control was obtained in 30 patients (85.7%). The median number of sessions per patient was 2 (range, 1-13). Post-APC ulceration was noted in 8 cases (22.9%). Two patients (5.7%) developed colovesicular fistulas, with 1 patient dying from this complication. A short interval between treatments (≤35 days) was associated with an increased risk of ulcer or fistula formation.


CONCLUSIONS
APC is an effective treatment for patients with medically refractive radiation proctitis after dose-escalated radiation therapy, frequently controlling bleeding after only one or two sessions. However, rectal ulceration is a common complication, along with a small risk of life-threatening toxicity.
Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York; Department of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, New York. Electronic address: joseph.p.weiner@gmail.com.
Joseph
J
Weiner
Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York; Department of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, New York.
David
D
Schwartz
Department of Gastroenterology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York; Department of Gastroenterology, State University of New York Downstate Medical Center, Brooklyn, New York.
Manuel
M
Martinez
Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York; Department of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, New York.
Joseph
J
Safdieh
Department of Gastroenterology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York.
Ayse
A
Aytaman
Department of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York; Department of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, New York.
David
D
Schreiber
D000368:Aged; D000369:Aged, 80 and over; D057908:Argon Plasma Coagulation; D002908:Chronic Disease; D019583:Dose Fractionation, Radiation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000628:therapy*; D012189:Retrospective Studies