Natural history of late radiation proctosigmoiditis treated with topical sucralfate suspension

Rectal bleeding due to radiation proctosigmoiditis is often difficult to ma nage. We had earlier shown the efficacy of short-term therapy with topical sucralfate in controlling bleeding in the radiation proctosigmoiditis. We n ow report our long-term results with this form of therapy. The study compri sed 26 patients with radiation proctosigmoiditis. Sigmoidoscopically, 9 (34 .6%) patients had severe changes, 15 (57.69%) had moderate, and 2 (7.69%) h ad mild changes. Severity of bleeding was graded as severe (>15 episodes pe r week), moderate (8-14 episodes per week), mild (2-7 episodes per week), n egligible (less than or equal to 1 episode per week), or nil (no bleeding). Ten patients had moderate rectal bleeding, while 16 had severe bleeding. A ll patients were treated with 20 mi of 10% rectal sucralfate suspension ene mas twice a day until bleeding per rectum ceased or failure of therapy was acknowledged. Response to therapy was considered good whenever the severity of bleeding showed improvement by a change of two grades. Rectally adminis tered sucralfate achieved good response in 20 (76.9%) patients at 4 weeks, 22 (84.6%) patients at 8 weeks, and 24 (92.3%) patients at 16 weeks. This c hange was significant by Wilcoxon matched-pairs signed-ranks test. Two pati ents required surgery due to poor response. Over a median follow-up of 45.5 months (range 5-73 months) after cessation of bleeding, 17 (70.8%) patient s had no further bleeding while 7 (22.2%) had recurrence of bleeding. Al re currences responded to Short-term reinstitution of therapy. No treatment-re lated complications were observed. Ten patients had other associated late t oxicity due to pelvic irradiation in the form of asymptomatic rectal strict ure (N = 3), rectovaginal fistula (N = 1), intestinal stricture (N = 1), va ginal stenosis (N = 1), and hematuria (N = 6). Three patients had progressi on of the primary disease in the form of pelvic recurrence (N = 2) and hepa tic metastases (N = 1). We conclude that topical sucralfate induces a lasti ng remission in a majority of patients with moderate to severe rectal bleed ing due to radiation proctosigmoiditis.