title: Outpatient application of formalin for chronic rectal bleeding after prostate irradiation: a quasi-experimental study.
abstract: OBJECTIVE
  The aim of this quasi-experimental study is to evaluate a novel technique for an outpatient application of formalin for chronic rectal bleeding after prostate irradiation.
  
  
  METHODS
  This is a quasi- experimental clinical trial developed between January 2010 and July 2015, including 35 patients with chronic radiation rectitis (CRP) due to a previous prostate radiation course. The study's eligibility was (1) completed external beam radiation therapy for prostate carcinoma >6 months previously, (2) rectal bleeding, defined as a frequency of >1× per week and/or needing of blood transfusions, and (3) diagnosis of chronic proctitis at colonoscopy. The 5% formalin application was performed by a custom applicator, which requires neither anesthesia nor sigmoidoscopy. The endpoint of the study was bleeding cessation and hemoglobin level.
  
  
  RESULTS
  The onset of bleeding due to chronic rectitis was 12 months (6-36). During a median follow-up of 24 months, the rate of overall efficacy was 94%. The sustained complete response in 1 and 2 years was 80% and 73%, respectively. The Hb mean pre- and post-treatment differed significantly (12.2 vs 14.4, p = 0.0001). The rates of blood transfusion differed significantly, pre- and post-treatment (17% vs 5.7%, p = 0.031).
  
  
  CONCLUSIONS
  The technique is very effective and safe, resulting to a significant improvement of hemoglobin levels and quality of life scores. Further studies are warranted to compare this technique with other treatment options for chronic radiation-induced rectal bleeding.
authors.affiliation: Oncoclinicas institute, São Paulo, Brazil. gusviani@gmail.com.|Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil. gusviani@gmail.com.|Faculdade de Medicina de Marília (FAMEMA), Marília, SP, Brazil. gusviani@gmail.com.
authors.forename: Gustavo Arruda
authors.initials: GA
authors.lastname: Viani
authors.affiliation: Faculdade de Medicina de Marília (FAMEMA), Marília, SP, Brazil.
authors.forename: Aline
authors.initials: A
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D005557:Formaldehyde / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010045:Outpatients; D011467:Prostate / Q000528:radiation effects*; D011832:Radiation Injuries / Q000188:drug therapy*; D012007:Rectum / Q000473:pathology*
chemical_list: D005557:Formaldehyde
keywords: Formalin; Prostate cancer; Radiotherapy; Rectal bleeding